Providing value-based care to patients requires a thorough understanding of their conditions and outcomes, along with clear insights into the nature of the care they receive. For the ACO, such insight and understanding comes from skillful analysis of a broad range and large volume of patient-specific data. In 2019, the ACO met a major milestone for increasing data analysis capability by loading clinical records into its database, complementing previously available claims information. Nearly a billion clinical records were combined with 500 million claims records to offer unprecedented data richness and opportunity for meaningful analysis. What did this mean in practical terms in 2019?
For the Local Value Oversight Committee at Western Maine Health Care, it meant a deeper understanding of emergency department utilization at Stephens Memorial Hospital. When preparing to address high rates of avoidable ED utilization, the Committee turned to the ACO team to help analyze current and past utilization and identify opportunities to improve. Tapping into the ACO’s clinical and claims data, the team revealed year-over-year trends at the population level along with utilization rates by diagnosis and utilization rates of each provider’s patient panel. They also helped expand the committee’s insights into patient behavior by including their utilization of non-MaineHealth facilities, information only available through claims data.
The ACO’s Arcadia data tool revealed lower month-to-month ED utilization in 2019 compared to 2018 for one Western Maine primary care practice.
For specialist providers, richer data meant a clearer view of opportunities to improve clinical documentation. Working with providers at Specialty Solutions, the ACO team dug into diagnosis coding patterns at specialist practices, discovered the most commonly used codes and assessed their level of specificity. That process revealed specific opportunities to increase coding precision and more accurately convey the acuity of patients’ conditions. Using that information, the ACO and Specialty Solutions developed precision coding tools for nearly a dozen specialties.
And in general, greater volume and diversity of data enriched the ACO priority projects’ access to timely information. During 2019, project teams working on admissions/readmissions reduction, avoidable ED usage and documentation improvement all included data analysts who contributed sophisticated data reporting to the planning, implementation and evaluation of each team’s strategies and tactics.
In short, 2019 was a watershed year for deepening the ACO’s data collection and analysis capabilities.