RFP Checklist for your ACO Platform
Designing an open platform of clinical trust with antiquated vendors who naturally distrust one another to guard revenue and sourc code is the number one challenge I have heard from ACOs, self-insured entities and other risk-bearing firms.
I hear the pain of aggregating this data with all of its complexities from CEOs, CMOs, and CIOs every day. Yet, we all hang in there knowing that the new path will reveal a way forward to “one direct source of-and-to the truth”. Big data promises to be our roadmap, and those that expeditiously manage the roadblocks will have the competitive edge and a value proposition that can be spoken with confidence every time.
When designing your RFP questions, consider the following in your ACOs RFP discovery:
- Enterprise model with access to cross-continuum patient data- EMRs, lab results, radiology, patient data, medical and pharmacy claims, case management, and post-acute care are all centrifugal, but your platform needs to be able to accept, query and report on new types of data, pervasive data. This is the real, real-time data.
- Population health management for comprehensive disease management and prevention.
- Care management comparisons to evidence-based clinical practice guidelines. Find your ACOs quick wins and your barriers to care issues.
- Performance management to monitor achievement of quality, utilization, and cost measures
- Transparent physician reporting, including peer-group comparatives that enables having the difficult performance conversation without words.
- Physician pay-for-performance attribution model capabilities
- Vendor experience with information system interoperability and the aggregation of data from multiple sources across the continuum of care, including EMR systems.
- Tool sets and visual presentations intuitive for physician usage, including web-based dashboards that provide access to data anytime, from anywhere. SaaS delivers best, but many organizations have data-breach concerns. Ask the security protocol question. Role-based infrastructure will safeguard compliance, security, and PHI considerations
- Data aggregated into measure summaries for easy monitoring to drive aggregate performance to participate in shared savings
- Drill to member and claim detail for compliance analysis to proactively identify gaps in care at the member level, but also able to roll-up community-wide reporting
- Identify gaps in care by member, provider or provider location to take actions to close gaps and improve performance
- Ready-to-use tools to perform outreach to members and providers to measure variation across providers & identify best practices
- Domain expertise to help Pioneer ACO and MSSP submission needs to generate CMS compliant measures for reporting. In the 33 quality metrics, the first 13 are for better care for individuals, and 14-33 are for better care for populations.
Something to think about: Plan, design for and expect a 3-month lag in CMS data. Patient-reported data presents the most risk.
CJ Fulton is the Director of ACO and Government Consulting for ZeOmega. He brings over 17 years of diversified international experience in HIT, population health design, and innovating new health care models for payers, providers and value-based care organizations