Why ACOs Must Capture Clinical Data to Truly Drive Care Improvement
By Daniel J. Marino, President & CEO, Health Directions
As ACO leaders shift their attention from high-level planning to working out the nuts and bolts of operations. The main challenge is learning how to manage performance under Medicare’s 33 quality measures. Success or failure will be determined by how well an ACO can create effective change in clinical processes.
The first priority is to develop processes for capturing the data needed for reporting. But reporting quality data is just the tip of the iceberg. The underlying aim of the quality measures is to provide more coordinated care. Caregivers will need to adopt new behaviors and practices, and ACOs will have to create tools to support new clinical behaviors and actively manage care coordination. This in turn will call for a broader approach to healthcare information. ACOs will need to capture clinical data not only to report measures but also to drive care improvement initiatives.
How Can ACOs Create Targeted Change at the Clinic Level?
Leading organizations are taking a systematic approach—translating each of the 33 quality measures into clinical processes, programs and information systems that drive reporting and improve clinical outcomes.
Case in Point
Operationalizing Measure 12. One of the core strategies of accountable care is to reduce errors and improve patient outcomes through better medication management. ACO Measure 12 supports this goal by requiring organizations to report the percentage of patients who receive timely medication reconciliation after discharge from an inpatient facility. While the measure is straightforward, the underlying problem is complex. Patient hospitalizations usually involve several medication changes, and hospitals do not consistently communicate discharge medications to primary care physicians and other treating providers. Physicians are often unable to determine the rationale of discharge medications and may have a hard time incorporating new drugs and doses into revised care plans. Disjointed medication management—especially for patients with multiple comorbidities—results in post-discharge complications and hospital readmissions.
Considering the full scope of the problem, what does an ACO need to do to operationalize Measure 12? Start with the patient’s needs at discharge and work backwards. The following example illustrates one possible approach:
In most organizations, providers will need to put more emphasis on consistently providing medication reconciliation for recently discharged patients. Nurses may need to adopt new processes for documenting and verifying current medications, and physicians will need to incorporate medication reconciliation into standard practice patterns. All providers will need to document medication reconciliation correctly, which may require additional training.
To perform medication reconciliation in the post-acute clinic, physicians and nurses will need consistent access to discharge medication lists. Create interfaces for pulling discharge medications by drug name, dose, frequency and route from the hospital information system. Building a discharge medication list may involve establishing electronic feeds from hospitalist, specialty consultant and discharge planner notes.