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Large Pioneer ACO Outlines Role of Clinical & Business Intelligence in Value-Based Care

CHICAGO (November 15, 2012) – As patient care models evolve to value-based care, clinical and business intelligence (C&BI) tools are playing a central role for organizations operating under new payment models. HIMSS Analytics published a new white paper titled “Banner Health Network Pioneer ACO Clinical Intelligence & Business Intelligence Approaches” that looks at how Banner Health Network is designing and implementing C&BI to effectively operate in a value-based care model.  

Headquartered in Phoenix, Ariz., Banner Health Network (BHN) is one of 32 organizations selected in 2011 by the Centers for Medicare and Medicaid Services for its Pioneer Accountable Care Organization program. BHN stood out as a Pioneer candidate since it had experience coordinating care across multiple patient care settings. BHN expanded an existing ACO relationship with Aetna to include full technology and analytics support for its ACO patient populations. The report covers the results of in-depth interviews with BHN executive staff to explore the organization’s progress and multi-layered approach to C&BI.    

Banner Health Network – the Organization: With the overall mission to provide excellent patient care, BHN followed three key drivers, identified as the “triple aim,” from the Institute for Healthcare Improvement. BHN had an existing infrastructure to support claims payment, medical management, customer service and other health-plan-like activities, which gave it several critical components needed to support the Pioneer ACO model. In addition, senior leadership viewed existing healthcare fee-for-service payment models as unsustainable. As noted in the white paper, “We are moving from an acute care system to a more comprehensive delivery system that is more viable and stable,” says Dr. Tricia Nguyen, Chief Medical Officer.

Clinical & Business Intelligence in Action: Because BHN is transitioning from fee-for-service payment and incentive methodology to a value-based methodology, physicians must receive the right information at the right time to drive more efficient patient care that results in higher quality outcomes.  Adhering to this philosophy, BHN used C&BI to:    

  • Implement payment codes that encourage and reward physicians to spend more time reviewing patient risk scores and profiles based on data gathered from BHN information systems that inform physicians about the status of their patients.
  • Manage and refine communication with specialists to help motivate them to follow processes that align and coordinate patient care with BHN standards.
  • Leverage business intelligence to track gaps in care, healthcare risks, communication plan effectiveness, and to benchmark progress toward the desired change in physician and patient engagement.
  • Establish executive level support and leadership through a Business Intelligence Data Governance program, managed by the Executive Steering Committee, with clearly defined roles and responsibilities for each level of data governance to avoid information silos. 

“Our research with Banner Health Network provides valuable insights into how this health system leverages clinical and business intelligence in transitioning to a new model of accountable care.  The BHN executive team supports the use of C&BI tools to better understand patient populations and offer patient-level care coordination with high-quality, standardized information,” says James E. Gaston, Senior Director, Clinical and Business Intelligence, HIMSS Analytics.

Collaboration for a Technology Solution:  At Banner Health Network, the distinction between clinical and business intelligence often overlaps, impacting business performance and optimizing patient care.  To better manage C&BI efforts, BHN expanded its existing ACO relationship with Aetna to include technology to better support its value-based care models and patient populations. This support covers population health management and patient services for more than 200,000 Banner Health Network patients, including more than 50,000 Medicare fee-for-service patients who are part of the Pioneer ACO savings program.

The Aetna Accountable Care Solutions (ACS) technology helps physicians see patient data at the individual and population level, and predict risk and opportunities for health and wellness programs. It also enables them to track, monitor, coordinate and report on patient health outcomes.  BHN provides physicians a comprehensive care management model supporting Pioneer ACO efforts so that patient engagement happens in a more meaningful way, including nursing home and palliative care. Using the Aetna ActiveHealth technology care management programs and outreach, BHN is at the early stage, but leading edge, of building and designing true population-based health management tools.  

“Value-based care requires physicians to understand and impact the health of individuals and populations of patients, particularly those with chronic disease where intervention and management is key to better health outcomes and cost. The range of technologies from our Aetna companies complements Banner Health Network’s technology to empower full clinical integration and intelligence,” said Charles D. Kennedy, chief executive officer, Accountable Care Solutions from Aetna

Read “Banner Health Network Pioneer ACO Clinical Intelligence & Business Intelligence Approaches” at www.HIMSSAnalytics.org/research on the HIMSS Analytics website. Contact James E. Gaston at James.Gaston@HIMSSAnalytics.org for more information on this research.  

About Aetna
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.   

About HIMSS Analytics  
HIMSS Analytics is a wholly owned not-for-profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS).  The company collects and analyzes healthcare information related to IT processes and environments, products, IS department composition and costs, IS department management metrics, healthcare trends and purchase-related decisions.  HIMSS Analytics delivers high quality products, services and analytical expertise to healthcare delivery organizations, healthcare IT companies, state governments, financial companies, pharmaceutical companies, and consulting firms.  Visit www.himssanalytics.org for more information.
 
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Media Contacts  

Joyce Lofstrom/HIMSS
jlofstrom@himss.org +1 312-915-9237

Sherry Sanderford / Aetna
sanderfords@aetna.com, 904.351.4592

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