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Payer-provider data transparency key to ACO success


In order for accountable care organizations (ACO) to successfully reduce costs and increase collaboration, insurers and providers must both develop more transparent policies and procedures for analyzing business and clinical data.

Cynthia Burghard, research director at IDC Health Insight, reached that conclusion in a blog post, explaining how data analytics are the key to ACO success. "One of the key contributors of previous reimbursement and business model failures in healthcare was due to the lack of transparency and tools," she wrote. "Transparency and consensus particularly on reimbursement and performance measurement will be critical to success."

She noted, however, that transparency must go both ways, meaning insurers and providers should collaborate rather than fight over data analysis. Burghard said the ACO participants should avoid discussing the accuracy of data, for example, by agreeing up front to use the same methodologies and terminologies, which also could help establish trust within the ACO relationship.

Insurers and providers also must be able to understand each other's data analysis. "Typically it will be a provider organization asking for health plan data so, from an IT perspective, the provider has to be able to accept the data from the health plan, understand how it's mapped, understand what the data means and determine how you're going to integrate that data with [the provider's] information," Burghard told InformationWeek Healthcare.

Additionally, insurers and providers involved in ACOs must have the knowledge and ability to use the data to meet accountable care quality measures. "Health plans and provider organizations will have to hire analysts that know both payer and provider data, so if I'm a provider and I'm bringing in all this payer data, I need to understand all the nuances of that data," Burghard told InformationWeek. "For example, they need to know what a member benefit means. There is just all of the domain knowledge about insurance processes and data that's really important to understand."

To learn more:
- read the Information Week Healthcare article
- see the IDC Insights blog

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