Data is everywhere.

Healthcare providers are often considered to be data hoarders. If possible, walking inside the typical data warehouse server of a healthcare system, you would see virtual stacks of data piled up in every corner, along the walls, and on every shelf. Most of the time we need special “data-finders,” people with advanced IT skills, to venture into the warehouse to find, among the piles of data, the information that managers and providers need to make important decisions.

Be of good cheer, because today there are data analytical systems that are fast, easy-to-use, intuitive, scalable, and affordable!

One of the early choices any Accountable Care Organization (ACO) must make is how to select their data visualization and analytics tool that makes data easily accessible. The Center for Medicare Services (CMS) provides a formula for success in the Medicare Shared Savings Program (MSSP) and NextGen ACO programs. Using data to meet or exceed CMS’s prescriptive path to success requires prudent use of claims data. Because most ACOs do not have an extensive technical staff, the decision around selecting your analytical solution will drive the success or failure of the organization. This analytical and visualization solution must help the ACO to survive and then to thrive as the organization grows and matures.

Sometimes physicians in their natural enthusiasm want every scrap of information instantly. Doctors often do not realize that it takes time and talent to process this information. While it is true that some analytic systems will guide you toward financial and clinical success, most of the technology on the market today just gives the hapless user a “data blob” to figure out. On the other hand, clinicians frequently complain about prescriptive “cookbook” medicine, but good cooks use a recipe every time so they get it right every time.

Successful ACOs usually start with the claim details in the CMS-Claims-Line-Feed (CCLF) file. This file should contain all the coded financial/clinical activity for the ACO’s attributed population. Granted, this information is a few months old and does not contain any laboratory results, recent clinical insight or visit notes; however, claims information is still a valuable resource. It is possible to track resource use, diagnostic course, calculated risk status, and preventive care track. In keeping with our analogy, the claims details allow clinical managers to take a “refreshing first drink.”

Under the current CMS guidelines, claims details alone are sufficient to lead an ACO and their physician partners toward improving patient care and achieving shared savings. Nonetheless, we all know that the MSSP model is not the end game. Long term ACO survival and success means moving the organization toward accepting some financial risk. It is then that relevant clinical information and even social determinants data will be required. This means that the ACO leadership should be asking their analytics provider now about their capacity to grow. It is increasingly practical for your physicians to manage the entire community population including Medicare, commercially insured, and those covered by Medicaid on a single analytical system. It is then that the physician’s natural enthusiasm for insights makes sense. “Stay thirsty my friend.”

About the Author

Craigan Gray
Craigan Gray, MD, MBA, JD

Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings rich experience from private practice, hospital leadership, and governmental health-benefit programs. Prior to joining Salient, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. In addition to an MD degree, Dr. Gray holds an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.