Designed to provide support to healthcare entities in their transition from Volume Based Care model into Clinical Outcome/Value Based Care model.
As everyone in the health and medical care industries knows, the healthcare system in the U.S. has been shifting very quickly over the last five years, with sharp focus on delivering quality healthcare to all citizens at a lower cost. In order to support healthcare entities in their transformation path from a volume base care model to a clinical outcome or value base care model, System Technologies offers the ACO-SST.
Most of the current and future care and payment models are based on the “Triple Aim” mission, incorporating the three main pillars of the Affordable Care Act (ACA) as implemented in 2011 by the Obama Administration.
Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
Improve the health of the U.S. population by proven support interventions to address behavioral, social, & environmental determinants of health.
Reduce the cost of quality health care for individuals, families, employers, and government.
Some of the healthcare entities who will need a software platform like ACO-SST to support their transformation process include Ancillary Service Providers, Accountable Care Organizations (ACO-SSTs), Patient-Centered Medical Homes (PCMHs), Healthcare Integrated Delivery Systems (IDSs), Multi-Specialty Physician Groups, Management Service Organizations (MSOs), Independent Physician Associations (IPAs), Hospitals, Health Plans/Insurers (Payers), etc.
To fulfill the Triple Aim mission, ACO-SST has been designed to provide healthcare entities with a set of Population Health Management and Predictive Analytics tools. It is based on Service Oriented Architecture (SOA), is web-based, and utilizes .Net and MS SQL technologies.
The ACO-SST system is built upon a very sophisticated data warehouse and consists of highly advanced ETL, Data Analytics, and Predictive Modeling logic. The process starts with data gathering activities and creating a sophisticated late-binding data warehouse. Data is collected from several disparate systems and standardized into Unified Medical Data Set (UMDS).
Some high level advantages and market needs of Population Health Management systems like ACO-SST are listed here:
Better Health Outcomes: The ultimate goal of Population Health Management (PHM) is simply improving the quality of care while reducing costs.
Preventing Diseases: PHM improves the care of those with chronic and costly disease by using IT solutions that track and manage their care.
Closing Quality Care Gaps: A fully-integrated BI tool helps close gaps in care by allowing organizations and physicians to have real-time access to track and address patient needs. Laboratory, billing, electronic health record and prescription data is all incorporated and providers can easily pinpoint unmet needs and gaps in data or service delivery.
Cost Savings: As with all advances in healthcare management, population health management is a win-win. By leveraging data analytics, PHM improves clinical outcomes while reducing costs.
The ACO-SST product has been designed based on Service-Oriented Architecture (SOA) and it is a Web-based product which will utilize .Net and MS SQL technologies.
The product offers the eight modules listed below which are designed to create a "loosely coupled, but tightly integrated" system.
The Population Health Management (PHM) module is the heart of ACO-SST system and supports the Care Continuum Alliance PHM model. The PHM module takes data from Health Risk Assessment (HRA) surveys and creates a data warehouse using clients’ historical medical claims, prescription claims, lab data, other ancillary data, and client billing system data, and then creates a standardized data warehouse using the UMDS model.
Population Health Management module also has ability to meaningfully join data from payers, hospitals, physicians and other ancillary providers to create a holistic view of population and monitor and track high cost patients, frequent ER utilizer, avoidable readmission and several other risk profiles to manage utilization and cost for risk based contracts.
Population Health Management (PHM) module is further divided into 6 sub-modules. Click here to see the details of each.
The Quality Measures module in the ACO-SST system is designed to meet federal and state quality reporting needs. Currently, this module is designed to monitor all 33 quality measures distributed in 5 main domains, which are defined by the CMS for Accountable Care Organizations (ACO-SSTs). The Quality Measures module gathers data from historical claims, lab results, CAHPS / HOS surveys, and clinical data from Electronic Medical Record (EMR) systems.
Quality Measures calculations are based on NCQA technical specification. Above is a pictorial view shows overall quality measures we currently have in system.
The Performance Benchmarking module in the ACO-SST system provides comparison of several healthcare cost categories and procedures against national averages and regional averages costs across population by location, by physician groups, or by individual physicians. Analytics produced in this module helps practices understand the overall cost of their attributed patient population and how it compares to national and regional average cost.
The average in-patient hospital cost is around 52% of overall healthcare cost and if attributed population has in-patient hospital cost higher than 52% then it means that population has higher utilization of hospital services then national average and physicians can target this area to reduce overall cost by reducing hospital utilization for their patients. There are several other dashboard graphs which compare cost based on 100 most common inpatient services, 30 common outpatient services, and all physician and other supplier procedures and services performed on 11 or more Medicare beneficiaries.
The Risk Stratification module in the ACO-SST system categorizes patient populations in high risk, medium risk, and low risk populations, based on their overall risk scores. Risk scores are calculated based on historical utilization of healthcare services.
The CMS-HCC model has been used in ACO-SST system to calculate risk scores of each patient. Depending on patient risk category, it will help practice design intervention strategies for each population category. Below diagram provides details on some standard criteria used to distribute patient population in one of below 6 risk categories. As you move from left to right in below diagram risk of patients increases.
ACO-SST - Risk Stratification module is further divided in 6 sub-categories to categorize population at much more detailed level. As you can see in the diagram on average only 20% population is consider high risk population which requires more exhaustive care coordination and multiple interventions to keep their disease and overall cost in control. Click to see Diagram
This module in ACO-SST is capable of categorizing high risk patients into various intervention categories based on enrollment and engagement strategies of individual clients. Both health assessment and risk stratification are key strategies within the ACO-SST framework.
This module has the ability to categorize high risk patients into various intervention categories based on enrollment and engagement strategies of individual clients. The attached diagram provides PHM process framework built in our system. Our patient engagement and intervention strategies process begins with the identification of a patient population and flows through the entire process of delivering interventions, ending with concurrent measurement as shown in below diagram. Both health assessment and risk stratification are key strategies within ACO-SST framework. These strategies enable providers to understand patient needs so that appropriate care strategies can be offered based on risk level. Interventions, from health promotion to risk modification to care coordination to active care management, then can be provided to subpopulations. Click to see Diagram
The Directives module supports overall patient engagement strategies. This module contains an interactive healthcare directive form. This form can be filled out by patient to inform their physicians on how they want to involve physicians to provide healthcare treatment to them in a scenario where he/she is not in a condition to make decisions or communicate their wishes.
The Provider Referral Management module helps practices identify high cost specialists, hospitals, and other healthcare facilities. This module is updated with the latest NPI data on a monthly basis. The NPI database is centralized, and contains all healthcare professionals and entities involved in healthcare delivery.
Client practice can use this module to search for particular specialists or hospitals to refer their patients. The search result will mark healthcare entities which have higher cost then national average cost for selected procedures or treatment. This results can be used by or client to refer their patients to appropriate healthcare facilities as they feel appropriate.
The goal of the built-in backbone of ACO-SST, the Integrated Healthcare Enterprise platform, is to facilitate access to and retrieval of clinical data to provide safer and timelier, efficient, effective, and equitable patient-centered care. The system will take data from various health care systems using HL7 Clinical Document Architecture (CDA) specifications to create a centralized data warehouse. Patient survey data will also get integrated in centralized data warehouse.
IHE/HIE platform is backbone of ACO-SST solution. IHE platform used to communicate and gather data in one centralized data warehouse for reporting, analytics and predictive modeling. IHE framework has ability to collect real-time data from healthcare enterprise locations and physicians EMRs and practice management systems through HL7, CCDA, XML, and other standard EDI protocols. IHE platform also has capability to collect real-time data from lab, pharmacy, hospitals, outpatient surgery centers, specialty physicians, radiology & federal/state HIE.
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