Baseball And ACOs: What It Takes To Go The Distance

Adam Gale, President, KLAS

You baseball fans know very well what October means for the sport: the MLB playoffs, or head-to-head series composed of best-of-five or best-of-seven game scenarios. Having grown up just outside of Baltimore, I’m ecstatic to see the Orioles make it into the playoffs and host their first playoff game in 15 years. While each game is important itself, it is the combination of games that tells the story of that particular series. At times, that story can be very compelling and exciting, such as Boston’s great comeback against New York in 2004.

Such is the case with the future of healthcare moving toward accountable care. It is an exciting shift in the way our nation will deliver healthcare. However, the ACO picture is complex, and in planning for it, providers must understand its individual elements, including related technologies that directly support it.

John Halamka, CIO of Beth Israel Deaconess Medical Center, has said that ACO = HIE + Analytics. As we hear more about providers’ strategies and understand how they plan to meet challenges surrounding ACOs, KLAS has expanded Dr. Halamka’s equation:

ACO = (HIE + Analytics × CDS) ÷ Patient Portal

As Dr. Halamka recognized, part of what has to happen for accountable care to take place is the exchange of information and collaboration across the continuum of care. Similarly, clinical quality improvement via robust analytics (business intelligence) is a necessity in an accountable care environment. Beyond HIE and analytics, KLAS has found many providers insisting on clinical decision support systems to standardize better care and eliminate redundancies, which is essential in the belt-tightening structure of ACOs that focuses on reducing healthcare costs. How do the patients themselves play into this ACO picture? Enter patient portals. A patient portal engages patients in a collaborative relationship to help them stay healthy and be accountable for their own care.

While our equation simplifies the very complex accountable care environment, it illustrates what a large undertaking accountable care really is. The stakes are high, and providers know that the accountable part of accountable care may mean a financial hit for inefficient or duplicative care. Some hospitals are already being fined for readmissions.

As you tackle accountable care, what elements would you add to our ACO equation? Feel free to comment here.

In an effort to help providers, KLAS is publishing a series of reports between now and the end of the year that are important when considering accountable care. This series will include reports about ACOs, HIEs, business intelligence, clinical decision support, and patient portals. In preparation for these upcoming reports, click here to request the reports KLAS did last year related to these topics. Make sure to visit KLASresearch.com at the end of this month to check out our 2012 ACO report. In the meantime, I hope you enjoy watching the Orioles win the World Series!

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