David DiGirolamo, Partners In Care: Anatomy of an ACO Platform Selection

Date: 06.07.2016 | HITC Editor

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Patients want the simplest approach when it comes to receiving quality care. The integration of accountable care organizations aims to meet that demand for easy, simplicity and quality, but experts agree ACOs still need work. Sure, the ACO method, which involves groups of providers collaborating on patient well-being, provides a paved pathway to care for patients, but it still often leaves providers, health plans and other healthcare constituents wandering around in this vast, chaotic landscape.

If there’s anyone who can provide clarity on the subject, it’s David DiGirolamo, the vice president of Health Information Technology and Informatics, Partners in Care Corp., DiGirolamo has experience in both healthcare business and information technology, giving him unique insight into the demands being placed on an ACO and the capabilities of the solution provider segment to support their requirements. He recently spoke at 2015 Accountable Care & HIT Strategies Summit specifically on this topic, providing the audience with realistic expectations, best practices and tools for selecting an ACO platform (you can view the session in HD video at the ACO HIT Connect Media Portal).

Defining ACOs

According to Kaiser Health News, healthcare stakeholders like doctors, providers and hospitals voluntarily form groups, known as ACOs, to coordinate and provide high-quality patient care. By entering ACOs, these constituents may receive bonuses and share the savings they achieve by containing costs.

DiGirolamo says ACOs perform both care coordination and population health management, though these definitions differ based on who you talk to. According to DiGirolamo, this diversity is only natural based on varying ACO stakeholders and locations. In general, though, the distinction between care coordination and population health management boils down to the number of patients.

“We basically look at it as care coordination is the one patient at a time part of it, and population health management is when you roll it up into larger groups,” DiGirolamo said. “Bouncing back and forth between macro and micro is what an ACO does.”

A complex picture
Cost containment is just as an integral component to ACOs as quality. However, measuring saving, in terms of finances and time, identifying areas for improvement and then executing advancement strategies can be quite the challenge. As Health Catalyst explained, ACO leaders must consider organizational aspects like governance and board structure and analytics. They must also evaluate financial components, such as predicting costs association with population health management. ACO platforms were created to manage these complexities, though they add an additional element of confusion. Leaders often ask: Which vendor is right for my ACO?

The growing ACO IT marketplace 
Platforms are continually popping up to answer that question, as the number of ACOs and health IT in general grow. As DiGirolamo explained, for 2012, global healthcare is growing at a rate of 14.2 percent compound annual growth. North America, specifically, is growing at a rate of 7.4 percent.

“There’s a lot of pent up investment money, and there’s a lot of money being spent in the marketplace,” he explained. “So what you’re seeing is tons of vendors coming from all over the place just springing up and looking to grab a piece of the pie.”

Watch out for common myths
DiGirolamo stressed the importance of not believe everything you hear about what constitutes a quality ACO platform vendor.

Vendors know it all. Many purchasers find platforms and falsely believe the vendors have access to all necessary information. Clients must go into agreements with a healthy level of skepticism, especially as it applies to risk management, as many vendors don’t have this type of expertise.

Long track records in health IT mean more mature products. Time isn’t the answer to everything. Many vendors have acquired products that have merely been adjusted and repurposed to meet changing needs. In fact, the companies may have had an entirely different business model at the start, which means their projects are really just as new as up-and-coming businesses. Instead of considering only how many years a vendor has been around, look at why it entered the market in the first place. Your best bet is with a vendor who set out to build a population health management system from the get go.

Blue chip vendors have more resources and deeper expertise. In DiGirolamo’s experience, he’s found that expertise is even across the board. In fact, smaller companies often have more people who have gotten their hands dirty and gained knowledge through experience.

Between the growing health IT industry and the budding ACO platforms, it is vital for ACO leaders to implement an effective selection process. During his presentation, DiGirolamo gave guidance on this endeavor.

What Makes an Effective ACO Platform

There are many components that go into a successful ACO platform. These solutions must allow for more than just the exchange of data. There must also be a heavy analytics component that makes data actionable. ACO leaders should be able to use that information to make practices more efficient at the clinical level and improve care quality, which may require making data exchange a workflow component for providers.

“We can’t just come down from on high and just push procedures down,” DiGirolamo explained. “You inhibit people’s creativity. To some degree you need standards, but you need to rely on the talent of the clinical teams.”

DiGirolamo also stressed that the platform must support resource allocation. It should not only show how many patients are in a full population and how many clinicians. A platform should also allow ACOs to assign patients on whatever basis the ACO stakeholders choose. Moreover, there must be an acuity element that puts certain patients higher up on that assignment list.

DiGirolamo also highlighted what he calls proscriptive analytics. If ACO stakeholders realize they must improve in certain measurements, the platform should be able to come back says what they need to do to meet those goals.

To be sure, some of these ideas are still up and coming, as some ACO platforms have yet to adopt these strategies. However, they showcase necessary adjustments for the future of ACO platforms.

Selection process best practices
Finding an effective ACO platform is only one part of the equation. Purchasers must also ensure the vendor will be a prosperous partner. DiGirolamo advised ACOs leaders narrow their vendor list down to no more than 20 vendors before diving into this process.

Evaluate their website. It seems simple enough, but a website says a lot about a company. If the vendor doesn’t provide enough details on its website, investigate the reason for these information gaps when speaking with the sales department.

Request demos. ACO leaders should ask for these demonstrations before issuing their request for proposal to save time. While one to two hour-long web-based demos are a great starting point to narrow down options, DiGirolamo said these must be followed up with in-person walkthroughs as well, perhaps four or more meetings after issuing RFPs. Decision makers should be present by that final on-site demonstration for the top four or five vendors, as these executives can evaluate both the product and the vendor workplace. Executives should also take this opportunity to engage the vendor employees to see if they are passionate about producing quality work.

Align scoring with the RFP. ACO leaders can’t expect vendors to do well on scoring if the evaluation criteria aren’t listed in the RFP. This ensures all stakeholders are on the same page.

Research the company. Purchasers can never know too much about a vendor, and DiGirolamo does his due diligence whenever he’s evaluating a company. Scrutinize the vendor employees’ LinkedIn pages, request a list of all their clients within the last six months and follow up with those organizations.

The Final Evaluation

When ACO leaders have found the ideal vendor, they must review the platform in practice. What truly matters is how it functions on a day-to-day level. If there is too much overhead for clinicians or the platform is not yielding the intended results, ACO leaders must find a different solution. As with many components of healthcare, finding the perfect platform may take a trial-and-error approach.

David will be providing additional insights on the alignment of the vendor marketplace offerings to ACO market requirements at the 2016 Accountable Care & HIT Strategies Summit, September 8-9 at the Hyatt Regency McCormick Place, Chicago. Please email robw@healthcareitconnect.com to discuss speaking opportunities or to receive information regarding participation as a sponsor.

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