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America Does “CARE” – But ACOs have Real Time IT Challenges

Hot on the heels of healthcare revolution in the U.S., the ACO model has been gathering steam lately. Dominantly ignited by factors like under-performing healthcare system and higher care cost, ACO model came as a sort of respite for the U.S. populace. According to a recent study conducted by a management consulting firm, there are about 25 to 31 million Americans who are currently receiving health care services from an Accountable Care Organization (ACO) and more than 40% of Americans live in areas with at least one ACO. The numbers are rising steadily. However, there are still operational bottlenecks that are pervasive and deter caregivers to join the ACO force.

Unlike pay for services’ model, ACOs success largely hinges on optimized coordinated care ensuring 2 critical objectives are met.  #1. Shorten Decision Window for Care Co-ordination. #2. Ensuring Consistent Connection with Patients.

As the success of an ACO model relies on ensuring quality care and reducing care cost, there’s a tighter room for profit, which can only be realized if the above objectives are met. These objectives might seem mutually exclusive at first sight, but the common thread that binds their success is the Real-Time capturing, monitoring and communication of various data. Let’s see how these real-time analytics will play a mission-critical role in complementing the success of ACO model.

1. Shorten Decision Window for Care Co-ordination

Patients come with various chronic conditions. These chronic conditions cannot be standardized as there will be a huge combination of health factor that is unique to a patient. Forming a case for a patient with multiple chronic conditions will require real time coordinated efforts with other dispersed physicians and hospitals across dispersed geography. In order to shorten the decision window, capturing and communicating real-time data with dispersed hospitals like health record keeping, patient’s health indices, prescription status, prognosis alerts, time stamping, etc. are crucial. By providing a platform to communicate real-time and deadline based alerts integrated across workflow with dispersed participants, care quality can be improved upon.

2. Establishing consistent connect with Patients

For ACO model to succeed, consistent connection between patients, hospitals and physician office is paramount. This is especially relevant during an emergency situation where the patient sees out of network specialists in the absence of real-time connect and physical presence thereby increasing the cost of care.  During such a cases, real-time monitoring and prognosis of  patients can come as a savior in order to curtail care costs, managing risks and monitoring clinical data. Even inside the hospital premise collecting data about patient’s presence is critical in order to build a workflow with alerts around patient’s locomotion with respect to his stranded location, equipment availability, waiting time lapse and thereby reducing waiting time for proper care.

Balancing Act

The ACO model walks on a thin rope which requires a balancing act between cost of care and improving quality of care.  Enabling both ends meet requires IT & Business intelligence (BI) diplomacy to bridge the gap by allowing a platform to shorten decision cycles and enable real-time prognosis for better care and improved profit sharing.