Background

For both public and private payers, accountable care organizations (ACOs) have begun to play a role in efforts to manage the rising cost of health care. In such an arrangement, a provider system enters into an agreement with the payer to oversee care for a defined patient population; the agreement specifies measures for how well the provider controls cost and maintains quality.  The payer and the provider share savings resulting from successful cost control – reducing cost measures below agreed-upon target values, while still meeting quality standards.  (Some agreements may also require the provider to share in losses – when the provider fails to reduce cost measures to meet target values.)

A provider system taking on this population health management responsibility receives ongoing data streams about services the relevant patients consume – services delivered both within the ACO provider system and by other providers – so it can monitor its performance against the cost and quality targets specified by the agreement. Management of, and access to, this complex data resource is critical to population health management.

Goals of the engagement

A regional provider system entered into multiple ACO arrangements with public and private payers. Leadership wanted to manage care for the various populations with a common strategy and monitor progress toward the ACO targets, but was not satisfied with the vendor then providing a solution.  They engaged Compass to receive all of the data streams describing services members consumed, to store the data securely in a common format across ACOs on Compass servers accessible to ACO staff, and to produce both regular reports and situation-specific analyses.

Tasks performed

Compass took responsibility for understanding both the commonalities and the differences among the various input data streams and structured a data store to accommodate both. Once the initial tables were designed and built – a task taking less than 90 days – Compass continued to process monthly updates and adapt the process as necessary to handle changes in the incoming data streams.

Compass made the resulting data stores (marts) available to ACO staff to perform their own analyses using SAS on Compass servers through a secure connection.

Compass worked with the data scientist at the provider system to:

  • Examine the quality and completeness of each population’s data and, to the extent possible, compensate for deficits
  • Assign risk scores appropriate to the population
  • Produce reports enabling primary care organizations within the system to gain insight into their relative performance on measures of efficiency and quality
  • Analyze each population’s use of services from providers outside the (ACO provider) system
  • Use standard service payment rates to assign prices to claims to analyze service intensity (facilitating a comparison of relative costs of services) in cases where the payer would not reveal actual costs
  • Highlight opportunities to reduce cost of the provider system’s insured employee population
  • Gain insight into the potential viability of the ACO

To carry out this work, Compass:

  • Maintained close contact with provider system staff
  • Developed a deep understanding of the incoming data and the payer measures
  • Responded to analytic requests immediately, delivering results as needed
  • Recommended ways to aggregate and display data to address management’s needs
Result

The provider system was able to generate accurate, actionable information to support its population health management efforts in a fraction of the time and at a smaller cost than in earlier attempts with other vendors. Compass is a trusted partner in the provider system’s efforts to deliver efficient, high-quality care to ACO populations.