ACO Rx: A Strategic Shift From Claims to Real-Time Network Data
KEY TAKEAWAYS
- Relying on claims data creates delays, incomplete patient views, and poor coordination between providers, leading to slower decisions and increased risk to patient outcomes.
- Access to real-time clinical data gives physicians immediate visibility into patient events, supports earlier interventions, and shifts care from reactive to proactive, which can improve both efficiency and outcomes.
- To fully realize value-based care, ACOs need to move beyond claims-based systems and adopt unified, real-time data platforms that improve collaboration, streamline workflows, and align providers around better patient outcomes.
For far too long, most ACOs have been relying on claims data to guide patient care plans.
That’s a problem.
Why? Because claims data often suffers from the same issues that afflict the infrastructure that produces it – namely, delays and fragmentation.
And in a clinical setting, these aren’t just annoyances. They can lead to administrative myopia and decision-making lags that impact patient outcomes.
A physician doesn’t have a clear idea of what has happened with a patient outside their own office. Or they miss a key symptom because of an incomplete patient record. Or they can’t reach a previous doctor due to outdated contact information.
When physicians lack a complete, up-to-date patient view, care decisions slow down and risks increase. That’s why ACOs need a real-time view of the patient – and claims data can’t provide it.
How Real-Time EHR Network Data Improves Patient Care
Patients shouldn’t have to reconstruct their medical history at every doctor visit. They come seeking answers, after all, not a barrage of the same old questions as if they have never met before. But when ACOs rely on delayed and fragmented claims data, that’s the no-win situation they’re setting in motion for patients and physicians alike.
Real-time network data – clinical data shared across providers as events happen, not weeks or months later through claims – helps shift the focus back to care by offering advantages such as:
- Immediate visibility into patient events outside the office.
- Faster awareness of care changes – without waiting on claims.
- Earlier cost estimation based on clinical context.
Most of all, real-time network data gives physicians a better chance to make quicker, more informed decisions. And that helps put the focus back where it belongs – on patient care.
From Reactive to Proactive: ACOs and Real-Time Insights
The delays and confusion associated with claims data keep healthcare organizations stuck in a reactive position. Rather than getting out in front of potential patient issues, physicians are constantly responding to things that have already happened.
Real-time network data, on the other hand, gives providers an opportunity to be more proactive in their approach to patient care.
For example, real-time alerts can enable timely transitions of care (TOC) interventions, allowing physicians to begin treatments earlier. Clinical context, meanwhile, can help explain why a patient was hospitalized, giving a physician the story of what unfolded rather than just a pile of facts to sort through.
The results? A chance to support proactive strategies for a patient to prevent readmission. Better tracking of external utilization and quality metrics. Care teams that can better allocate the right resources at the right times.
All of which leads directly to higher quality care and better patient outcomes.
Rethinking Data Infrastructure for Value-Based Care
Unfortunately, many ACOs are operating with data infrastructure that’s fundamentally misaligned with value-based care. Their current data ecosystems are overly complex and difficult to maintain, so they’re stuck relying mainly on claims data.
But rather than look at their current data limitations as an insurmountable challenge, they can instead see this moment as an opportunity to consolidate and outsource their data pipelines to a unified platform like the Zus Aggregated Profile.
In rethinking their data infrastructure in this way, they’ll discover the benefits of improved data sharing – particularly when it comes to how they collaborate with specialists.
How can an ACO help a cardiologist, for example, share data on a platform that can improve heart failure outcomes? A cardiologist, by the way, who doesn’t necessarily approach the cost of care the same way that ACO does – that is, by getting rewarded for improving outcomes.
A shared data source can lead to that shared goal. To a shift from a volume-based reimbursement model to an outcome-based alternative.
A Different Approach to Data = A Better Approach to Healthcare
The first step for ACOs looking to make this shift is to change how they treat their data. That’s how they can start inspiring the mindset change that can lead to better patient outcomes.
Because in order to deliver on the true promise of value-based care, they need to stop optimizing around claims and start building around real-time data.
We can help – get in touch to learn more.
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