HIMSS14: Pioneer ACO delivers

ORLANDO--Steward Health Care Network in Boston became one of five Pioneer accountable care organizations (ACOs) in January 2012 which meant it had 90 days to start meeting numerous requirements.

Dominique Morgan-Solomon, MPH, Steward’s vice president of population health, shared her experience running a Pioneer ACO during the Health Information and Management Systems Society’s annual conference.  

Steward itself has been around for three years, so the infrastructure required to manage populations wasn’t there, said Morgan-Solomon. “We had three nurses and 35,000 patients. We had a lot of work to get the program implemented in 90 days.”They leveraged several vendor partners and ramped up staff quickly.

The analytic component was critical, she said, because you can’t decide which programs to put into place until you have identified your population’s problems. Given the uncertainty of the Affordable Care Act and other factors affecting healthcare, Morgan-Solomon said she wanted to build a program that works regardless of a federal program that could be canceled.

She made a point of making data actionable and informative for data-driven decision making to “find pressure points. Data are meaningless unless you understand the audience who is going to view the data.”

The Pioneer ACO effort makes healthcare a value proposition. “We have to drive quality and balance that against national benchmarks while driving down costs,” said Morgan-Solomon. They had the ability to save millions on Pioneer patients but if Steward didn’t meet its requirements, they wouldn’t get to share in any of the savings. To get there, they needed to collect information that is claims-based, clinical and patient reported. “If we don’t get that information we can’t get to predictive analytics.”

Steward’s analytic engines have to integrate those three sources of information. “Just one is not enough to get ahead of the curve. We’ll still be reacting instead of being proactive.”

Steward also utilizes a dashboard to track provider efficiency. When developing the dashboard, Morgan-Solomon said she knew they needed it “in the face of the people touching the patients. We needed nurses, social workers and pharmacists to understand what they look like compared to their peers.” She said she noticed that once nurses could see how well they were doing against the target, they were reinvigorated.  

The dashboards look very different depending on their audience, she said. They also are built to expand to manage a large Medicare population and a commercial risk population. Medical directors from Steward’s various clinics use the dashboard to engage in conversations with their employees.

Another challenge was the heterogeneity of both physicians and EMRs. In fact, Morgan-Solomon had to work with 81 different databases and none of the data were normalized. “Bringing all that data together is our new challenge, getting to the predictive analytics that takes us from good to great.”

To get physicians on board with the program, Morgan-Solomon said she spent a lot of time talking to doctors. While she acknowledged that money talks, she said it’s not the only lever. “If we’re going to make a promise, we deliver on it.”

The Pioneer ACO achieved a surplus in 2012, Morgan-Solomon reported, and improved overall care retention by 5 percent. She said current plans include continuing to advance data integration, advance physician engagement and seeking out more ways to collaborate with other providers and services.