Interview with KLAS’ Colin Buckley

Date: 05.15.2013 | Zach Urbina">Zach Urbina

KLAS Research

KLAS gathers healthcare technology market intelligence research worldwide and conducts nearly 2,000 healthcare provider interviews each month. The resulting reports are among the most sought after in healthcare and provide a diverse & thorough view of the industry during this time of considerable change.

We spoke with Colin Buckley, the Strategic Operations Director, at KLAS to hear more details about a report they recently compiled and released in conjunction with Leavitt Partners on accountable care organizations, entitled ACO 2012: The Train Has Left the Station.

Zach Urbina: Based on the findings of the KLAS ACO report, what are some of the initial opportunities for providers as healthcare reform moves forward?

Colin Buckley: At this early stage, the most that can be said about “opportunities” is that there are a lot of them.  In our report, we found many very different organizations tackling accountable care in a wide variety of ways.  It reminds me of the mountains that surround us here in Utah: depending on your skills and equipment, they can be crossed a thousand different ways.  Over time, some routes and methods prove to be the most successful and are repeated over and over.  We haven’t yet reached that point with accountable care, though some trends are emerging.

ZU: What are some of the best practices that have emerged from the leading pioneer ACOs? What are some of the practices that have proven avoidable from those same leaders?

CB: If early leaders had a mantra, it would be “Know thyself.”  The most defining element behind the success of these organizations is the use of data.  They tend to have extensive data warehousing and analytics programs in place—not to mention developing a culture that engenders their use.  Data dispels uncertainty and allows specific, measureable strategies to develop.  In fact, the “measurable” part is one of two pitfalls worth noting.  Sometimes organizations make huge investments without a concrete way of measuring plan for evaluating ROI in a way that will let them know if they are successful or to help them make course corrections along the way.  The second pitfall would be failure to deeply engage clinical staff to gain buy-in and ensure behavior changes on the ground.  It’s not enough to hand a process document or “hot list” of patients needing proactive attention.  These things need to be integrated into the cultural and clinical workflow of caregivers.

ZU:  While most ACOs are currently engaged in shared-savings arrangements, what are a few of the factors preventing the remaining minority from participating in such agreements?

CB: The easy answer is “uncertainty,” though an upside-only shared savings arrangement itself is a common way to limit risk. The bigger question is, “What prevents the majority from taking on downside risk or even capitation?” The answer is a lack of knowledge and experience. As organizations continue to build their data analytics capability, they will gain knowledge.  As they experiment with their upside-only shared savings or bundled payment agreements, they will gain experience.  For the majority of organizations in our study, their initial accountable care effort is seen as a learning experience.

ZU: How common are corporate wellness programs in the care coordination landscape? Are their numbers likely to increase or decrease in the coming years?

CB: I can’t speak to “corporate” wellness programs in particular since our research focused on provider programs (rather than employers and payers).  From the providers’ perspective, wellness programs are not a top priority—only 1/3 of those we spoke with said it was part of their care coordination strategy.  For the time being, they are focused on more direct interventions via care managers and patient centered medical homes. It seems that for the time being, there is enough “low hanging fruit” to be obtained by providing correct, consistent treatments in the right clinical settings.  Wellness programs may increase over time as focus shifts from “high flyers” to the health of the general patient population, though it remains to be seen.

ZU:  For organizations offering HIE solutions of seeking to participate in the EHR roll-out, what third-party HIE options appear to have a sustainable approach?

CB:  We’ve been tracking HIE roll outs for the past few years and have seen a strong uptick in the number of “private” HIEs being instituted as providers pursue individual strategies for coordinating care within the confines of their organization or community.  At the same time, some of the public HIEs have struggled to find the traction with providers and the consensus with stakeholders that are needed for sustainable funding models.  Some public HIEs are developing value-added services–like analytics and population health management–that may be welcomed by some of the more decentralized ACOs that are developing.  In our research, we found that ACOs led by independent physician groups are more likely to opt for a public HIE than building their own network.

From an HIE vendor point of view, there are still many, many options out there.  We counted close to 40 in our most recent study, but 11 represent about 80% of the market share.  We found that enterprise EMR vendors are having a great deal of success selling HIE solutions into their existing customer bases, but best of breed vendors are having success as well. Generally, both types of vendors are struggling to keep up with demand, especially when it comes to timely delivery of robust interfaces.  We have seen heightened interest in vendors offering additional functionality or services in areas such as data analytics, patient portals, and physician hand-holding.

ZU:  How are the physician-led ACOs differing in their approach to accountable care strategies vs. hospital-based health systems?

CB: They are coming at accountable care from their respective points of strength.  Physicians have more experience working directly with patients in a primary care setting.  Many have already built care coordination capabilities with initiatives like patient centered medical home.  Hospital-based health systems are more centralized in their approach, and often have a head start in gathering and analyzing data across the continuum of care.  Based on analytics, many have experience developing their own care process models.  What will be most interesting is how each type of ACO ends up filling its gaps–and how difficult it will be. Some physician-led ACOs don’t include hospitals and some hospital-led ACOs will rely heavily on community physicians. Some of the large IDNs get to bypass these challenges as they already “own” a large portion of the care continuum in their communities.

The entire 2012 ACO report from KLAS is available here.

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