The Importance of Implementing a Modern Data Infrastructure for ACOs

It’s no secret that healthcare data continues to be a complicated mess of mismatched formats and outdated, legacy information. As such, ACOs continuously face challenges on both how they acquire data, and how data is analyzed once acquired. 

This piece outlines an area of opportunity for ACOs to acquire streamlined data, leverage an easy to use technical infrastructure to ingest the data, and how to implement a modern cloud data platform to improve outcomes for ACOs and the populations they serve. 

Good Data = Successful Population Health Management

As defined by CMS, ACO’s are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients with the goal of coordinated care to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. However, it is important to note many ACOs also enter into value-based arrangements with commercial and Medicaid payers as well.  

To achieve this goal, ACO’s rely on data analytics and population health management, the process of utilizing healthcare data from multiple sources (neighboring health systems, various EHRs, etc.) to create improvement opportunities for a population of individuals. 

Heretofore, the acquisition of data needed for positive population health management outcomes has not always been easy to access, and one of the largest challenges facing ACOs today is the accurate and streamlined integration of data from out-of-network providers. 

Additionally, the expansion of ACO networks with additional facilities and providers has often correlated with a decrease in data returned to the primary care team (aka the team responsible for coordinating patient care) – further highlighting the critical need for ACOs to develop the technical infrastructure required to share data efficiently across multiple care sites. 

From the Ground Up – Technical Infrastructure is Key 

Another critical challenge facing ACOs today is the quality of their underlying technical infrastructure. AJMC conducted research across private sector ACOs, outlining the 5 following areas as critical success factors: 

1. Physician Involvement
2. Strategic Buy-In to the ACO Vision 
3. IT Infrastructure and Data
4. Experience and Understanding
5. Leadership

IT in particular was repeatedly deemed critical. One interviewee from the same AJMC study summarized the issue, “Well, an IT infrastructure is key. You can’t control what you can’t measure. You need to define your quality and utilization parameters. … You’ve got to build the structure right. You’ve got to have adequate data from your health plans so that you can figure out what you need to figure out.” 

The Solution: Reimagining the ACO Data Infrastructure 

The right modern data infrastructure can be leveraged as a tool to drive population health outcomes. While there are many tools already in place to generate population health data, what’s needed now is a way to connect and access both clinical and claims data, have a mechanism to transform disparate data into a uniform, clean FHIR® format, and to analyze it accordingly. 

With the recent advent of FHIR® (Fast Healthcare Interoperability Resources), ACO’s have the chance to gain a competitive advantage in both how they acquire and manage their data. For example, the introduction of Beneficiary Claims Data FHIR API (BCDA) by CMS now allows ACOs to access claims data on a weekly basis. With the right infrastructure in place, ACO’s can greatly improve the quality and timeliness of data they utilize to drive outcomes. 

In addition, by the end of 2022, all EHRs (Electronic Health Records) are required to provide access to bulk FHIR APIs enabling seamless clinical data exchange on a population-health level across provider networks. For the first time in history, ACOs can intervene earlier in the care process with more frequent access to claims data. Having both claims and clinical data in a common language will enable improved gaps in care identification, risk stratification and more. 

The Industry’s Most Complete FHIR Platform 

1upHealth is here to help ACOs make the most out of these industry changes, to start acquiring and utilizing data easier than ever before. With 1upHealth’s FHIR platform, the most complete in the industry, you can: 

1. Receive Medicare claims from CMS on a weekly basis.
2. Receive claims from commercial payers & Medicaid on a daily basis.
3. Consolidate clinical data across the provider network regardless of EMR. 
4. Push this more timely data into your current population health & analytics tools for more timely insights.

Implementing a modern technical infrastructure means lowering costs while improving care and optimizing the coordination of care and population health management. By taking the steps today to invest in the health of your technical infrastructure, you are committing to improving outcomes for your institution and your community. 

About 1upHealth 

Born from FHIR® to build the modern healthcare infrastructure of today, at 1upHealth 

we’re connecting an ecosystem of payers, providers, patients, life sciences and app developers within a trusted interoperability network. Our fully cloud-based and purpose-built platform is built to deliver broad-scale interoperability across a patient-mediated network of over 10,000 clinical and payer endpoints – allowing for greater ease and efficiency to improve patient outcomes, drive population-level analytics and enable medical innovation.