ACO-360⁰ Needs Assessment: Questions your ACO must ask
Guest Contributor: CJ Fulton
There are three things “new” to healthcare that really aren’t new at all: population health management (PMH), the patient-provider relationship, and the emergence of Health applications (mHealth, advanced diagnostic technology, etc).
PMH is hardly groundbreaking. In fact, the practice and proficiency of payers stratifying populations by risks, identifying high-cost conditions, and deploying member engagement strategies around disease management date back to 1929 in the U.S.
Patient-provider relationship? Well, it doesn’t have a Facebook flashback movie per se, but I did find a movie scene from 15 years ago that I think articulates this relationship and its history perfectly…
Lastly, new technologies have sustained a perpetual momentum in an industry where rapid change is accepted and expected. With tech change, apps are written on open source platforms where APIs can be layered with multi-directional fluidity. But caveat emptor: some health-tech companies are repackaging old methodologies, evangelizing, and attempting to retrofit their old square-peg platform into your new care circle.
No, the three aspects aren’t new, but the alignment and integration of PMH, the patient-provider relationship, and the emergence of heath IT have created a sort of healthcare Industrial Revolution.
Mapping systems of data (not siloes), managing relationships, and dispersing data in real-time on harmonized, open platforms is a capital investment that must provide significant financial and clinical ROI for every dollar spent. With the help of a Pioneer ACO and a Top 5 Hospital MSSP ACO, I have compiled a shortlist of ACO-360⁰ questions that will help you select an ACO platform that allows stakeholders to access their “internet of care things”:
1) Vendor viability and covering the basics to understanding their current business risk
A. Customer reference checks
B. Total revenue, operating margin, debt-to-equity ratio, R&D budget
2) Application Functionality
A. Have the vendor list national standards and sources used in assessments, care plans, particular interventions, etc.
B. Have the vendor prepare a brief narrative on how the ACO could use their platform in your care delivery enterprise (related to configuration hierarchies and role-based security).
C. Include two use cases: one that incorporates the lowest hanging fruit, and one for outliers to capture how the platform handles complexity
3) Technical Evaluation
A. Must have a correspondence engine: secure texting/email.
1. Security protocols?
2. Capability for importing address books?
3. How are incoming patient emails or texts handled?
4. How do you maintain phone numbers for texting?
5. How do you store texts and/or email? Is the content ever purged?
6. Is there a process by which care team members agree to establish a text and/or email relationship with a patient?
B. Care Snare Alerts
1. Have the vendor describe the capabilities and functionality of platform rules engine
2. Ask if the ACO can determine whether alerts are platform generated or rules engine generated?
3. How would alerts be coordinated with those already in place at the ACO?
4. What options are available for alerting? Email, phone, text, page, other.
5. Briefly describe how alerts are incorporated into user workflow?
A. Population Risk Management. Import or proprietary number that can be customized?
B. EHRs – What current integration do you have with EHRs? Please be specific in terms of the vendor/product and specific data imported and/or exported (e.g., ADT)
C. Do you currently integrate with any other ambulatory physician practice management platforms/EHRs?
D. Clinical Data Repositories (CDRs) – Do you currently integrate with any vended or proprietary CDRs? If not, please address future plans within the product direction section of ACO’s vendor evaluation.
E. List all formats which you currently support in integration including, but not limited to: HL7, CCD, CCDA, XML.
F. Please describe how you reconcile MPI.
G. PCP Attribution – Please describe how you handle PCP attribution, challenges you experience, and customer sites where PCP attribution is in productive use.
H. Assessments – please describe the ACO assessment engine in terms of capabilities, current customer usage, and future development plans.
5) Product Direction
A. Please describe lab, claims, PACS, medication coordination module, specifically addressing drug-to-drug interaction, pharmacy notifications, and med reconciliation.
B. What is the current version and release number? When is the next planned upgrade? How frequently do you deliver upgrades or product enhancements?
C. Are all hosted clients upgraded to the newest release at the same time?
D. Are hosted clients permitted to be on different versions or releases of the product?
E. Is platform Meaningful Use certified for Stage 2? Stage 2 requires providers to exchange information electronically with other providers, hospitals, patients, laboratories, pharmacies and public health agencies.
6) Cost/Value Proposition
A. Include TCO and 3-year cost matrix as applicable
B. How many resources (FTEs) are required from ACO to support an enterprise platform implementation? Please briefly indicate what skills are required.
C. What resources (FTEs) are required from the ACO to configure and support platform post-implementation?
D. Does Vendor provide consulting services? If so, at what hourly rate? Do customers typically require consulting assistance?
CJ Fulton is the Director of ACO and Government Consulting for ZeOmega, a leading provider of software for integrated care management. He brings over 18 years of experience in HIT, population health design, and innovating new health care models for payers, providers and value-based care organizations. CJ and ZeOmega will be exhibiting at HIMSS, February 23rd-27th at Booth #4373. To read more from CJ’s blog, go towww.healthideation.org.