- Data analytics and other health IT tools played an integral role in helping Next Generation Accountable Care Organization (NGACO) Model generate net savings of approximately $62 million for the Medicare program, states a new report from CMS.
Launched in January 2016, the NGACO Model involves the highest levels of financial risk out of any CMS ACO initiative. Unlike other ACOs, NGACOs have almost complete financial responsibility for outcomes, must take on downside risk, and have no minimum savings or loss requirements.
The high financial stakes required significant investment in data analytics tools to help identify opportunities to improve quality and reduce unnecessary spending.
NGACOs employed staff to fill health IT and data analytics roles, and leaders stressed the importance of developing health IT and data analytics capabilities to support the model.
To manage their patient populations, the 18 NGACOs included in the report integrated and analyzed an average of six or seven types of data, with Medicare claims, pharmacy, primary care, laboratory, and specialty care being the most common.
In addition to significant net savings, CMS found that beneficiaries receiving care within an NGACO experienced 1.7 fewer inpatient hospital days per month in comparison to non-NGACO beneficiaries, as well as 15.6 fewer nonhospital evaluation and management visits per month.
CMS also found a 12 percent increase in the amount of annual wellness visits for NGACO beneficiaries, indicating improved care quality.
Almost half of NGACOs stated that health IT has improved care coordination and chronic disease management in their organizations to a very large extent. Leaders said they use health IT systems and data analytics to identify beneficiaries in hospital and primary care settings who are in need of targeted care management.
Twelve NGACOs also reported using analytics capabilities to know in real-time, or near real-time, at least half of inpatient admissions among their beneficiaries.
However, many NGACOs cited extreme difficulty in accessing data outside of their organization or network, and nearly half said they struggled with interoperability issues within their NGACO.
Many reported that having multiple EHRs within their network prevented effective health information exchange for quality and performance improvement. Consolidating and integrating data from multiple EHRs also proved challenging.
To overcome these issues, at least one NGACO required all providers in its network to adopt a single EHR platform, a strategy that could enhance practices in other participating accountable care networks.
NGACOs also utilized health IT and data analytics to measure and track provider performances. Executives shared performance data with providers through reports and dashboards integrated into the EHR.
Health IT systems proved helpful in evaluating NGACO financial risk, as well. Twelve NGACOs said they used information systems to track utilization and manage financial risk. However, many cited difficulties with obtaining comprehensive or adequate data to accurately predict their expenses.
To improve risk forecast estimates, many NGACOs said they had to make costly investments and leverage consulting firms for their expertise.
Despite these challenges, many NGACO leaders who had experience with other ACO models reported that they generally preferred the NGACO model, and cited greater overall satisfaction with the NGACO model.
CMS expects that the NGACO model will result in further improvements in care delivery and patient outcomes.
“These results provide further evidence that ACOs succeed under two-sided risk. ACOs in the Next Generation Model are being held accountable with strong financial incentives and are provided with substantial flexibility and regulatory relief,” said CMS Administrator Seema Verma.
“They are delivering value and providing quality care to patients and taxpayers even in their first performance year, and we believe that these results are achievable for other ACOs under similar incentives.”