By Larry Allen, MD, MGMA member, and Chuck Kandzierski, COO, Clinigence
One of the biggest hurdles to overcome for physician-led accountable care organizations (ACOs) is faulty clinical data. Most ACOs’ population health efforts gather data from disparate member practices. If clinical data is not accurate, physician trust deteriorates. Since many physicians’ first reaction to data is to reject it, ACO leaders should confirm information before presenting it to physician members. At Goshen Health and Family Practice, a 50-physician primary care ACO that covers 100,000 people in Goshen, Ind., the journey from dirty data to clean, reliable information involved building trust, engaging physicians and ensuring ACO viability.
Under value-based care, physicians are scored by quality measures derived from clinical data. As a result, data must be accurate and meaningful. In Goshen Health’s early days, physicians would question the ACO’s data and were regularly surprised by negative quality scores. Reactions ranging from skepticism to disbelief were commonplace. Three specific issues emerged from Goshen’s initial member presentations:
A proven way to address the lack of trust in clinical data is to begin with easy wins. Focus on a quality measurement that provides an opportunity to improve performance and a high level of confidence in the numbers. With certainty achieved on the first measure, ACO leadership is better equipped to present clinical data findings for more complicated measurements, acknowledging up front the complexity and need to verify the scores.
Goshen’s ACO leadership performed manual chart reviews to validate the clinical data and determine root causes of disparities in performance around pneumonia vaccine rates. Data was reviewed at the practice, provider and patient levels. The ACO’s data validation review revealed dramatic differences in patterns for giving pneumonia vaccines. Other variations were seen in the administration of depression screening and renal function screening for patients on high-risk medications.
However, in most cases, the data was correct. Data validation helped providers gain more trust in the technology used to aggregate data from different EHRs and produce the appropriate reports. Clinical data validation also set expectations early in the process. Here are five important lessons for ACO leaders and physicians to consider:
Bad data is detrimental to reimbursement and patient health. Education, training and practical application of standardized policies and procedures are highly recommended to improve data integrity. During the clinical data validation initiative at Goshen and with other ACOs, four common reasons for inaccurate ACO data emerged:
By taking time to validate its clinical data, Goshen strengthened physician collaboration and ACO participation. Now, 95% of Goshen’s physicians have signed contracts to participate in the ACO and its value-based initiatives. Clinical data validation is also a critical step to ensure correct quality reporting under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Merit-based Incentive Payment System (MIPS) and other value-based reimbursement models.
This validation cycle is essential for every new metric to be reported. Consider the following practices based on lessons learned:
Data reliability has become a key challenge to improving population health and building successful partnerships within physician-led ACOs. If physicians don’t have faith in the data, they will not subscribe to the technology and methodology used to identify at-risk patients. An ACO’s ability to perform clinical data validation — when and where it is indicated — is paramount to securing physician confidence and establishing long-term support for population health programs.
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