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Accountable Care Solutions

In the transition to patient-centered and data driven healthcare, accountable care solutions developed by custom software will play an essential role. The fact is that data collection and analysis serves as the foundation for initiatives that track and seek to improve patient outcomes. The managed care approach of the 1990s ran into trouble, in part, because accurately predicting health risks and medical costs without access to digital resources simply wasn’t feasible. Today, electronic health records are widely implemented along with internet accessible medical devices, creating unprecedented opportunities for data mining and predictive analytics.

Quality
Metrics

Quality Metrics

Medicare
Billing

Medicare Billing

Database
Integration

Database Integration

ACO Software
Benefit
Plans

Benefit Plans

Wellness
Planning

Wellness Planning

Predictive
Analytics

Predictive Analytics

The Ideal Outcome for Accountable Care Organizations (ACOs)

With the commonly used fee-for service model that builds profit into each transaction, there’s no financial incentive for healthcare providers to reduce overall spending. Yet if healthcare organizations are penalized for providing costly but necessary services, there’s also a risk that patients will be underserved. The solution lies somewhere in between these extremes.

The goal of ACOs is to ensure that patients experience the best health outcome per dollar spent—whether that money is coming from patients or insurance providers. Various reimbursement structures such as shared savings and capitation payments are used to incentivize healthcare providers to reduce costs while improving quality of care.

Insurance companies, self-insuring employers, and healthcare organizations can all use accountable care solutions. While insurers have a long history of using every piece of data available to predict their risks and costs, employers and healthcare providers are playing catch up. That’s starting to change.

How Healthcare Providers Use ACO Software

Hospitals and group practices are using ACO data collection and analytics to identify areas for potential savings including:

  • Reduction in quality risks or errors (for example, managing prescription and administration of medications more effectively)
  • Improved guidance for differential diagnoses, (such as discouraging tests that would have no bearing on the course of treatment regardless of the findings)
  • Operational improvement (creating more streamlined workflow and supporting better utilization of resources such as infrastructure and supplies)

How Employers Are Using Accountable Care Data

For employers who are self-funding medical plans, predictive modeling engines offer the ability to estimate per-capita costs and predict future trends and costs. When employees make appropriate use of their available health coverage for preventive care rather than waiting until a health condition is catastrophic, employers benefit from lower health claim payouts—and workers benefit from better health.

Population health management is supported with systems that allow employers to gain insight into the complete health cycle of members as individuals and as a group. Employees don’t stay in the same risk category throughout the term of their employment and the makeup of the workforce itself is constantly changing. Flexible and up-to-date reporting and predictive analytics are vital to mitigate financial risk. Ayoka has been instrumental in bringing this type of accountable care software to market for our clients.

Drilling Down to Understand Health Data

A leading healthcare consulting company engaged Ayoka to build their next generation population health management software. Today, this enterprise application mines claims data and medications information from millions of employees at numerous, self-insured corporations.

As the benefits manager from a major construction company says “software that makes it easy to understand the data we already have available on our employees has helped us improve our benefits plans. We’ve been able to target specific messages to employees to help them with care and prevention, which has helped us significantly reduce our exposure to large claims, such as stroke and diabetes.”

Is your company looking to create an innovative software platform? Or is your organization struggling to manage the cost of healthcare and looking to improve wellness for plan participants? Ayoka can help create solutions that make a difference. Call us today to uncover the hidden insights in your data.