CRM and Data Need to Support Accountable Care Initiatives

Health providers using CRM to coordinate care outside of their physical facilities is a must.  The patient-centered view within CRM makes it an obvious fit for accountable care initiatives. A looming transformation in the personalization of healthcare makes the time right for CRM to make its way into healthcare.

It can be quite tempting for providers to use a band-aid approach and just add a few care gap and activity features into their existing HIS/CIS systems. Many of those systems were originally designed around the old fee-for-service model. These systems are healthcare-institution-centered, not patient-centered.

HIS/CIS systems were not intended for the level of contact required by accountable care initiatives. A physician who sees a patient twice a year has a much lighter activity management need than a care team who is collaborating with a patient and their care community on a regular basis.  Quite simply, HIS/CIS systems are not a good starting point to actually coordinate care. These older systems are not up to the challenge in terms of the numerous tasks, activities, calls, emails, and visits necessary to effectively collaborate between a patient, their family/community members, and a care team of multiple providers.

Accountable Care Organizations Internal and External Data Integration

It seems safe to say that the one thing everyone can agree on is the need for internal and external data integration to support Accountable Care Organizations. Depending on the number of ACO contracts with payors, the challenge to source external data for ACO membership/enrollment and claim data can be significant. 

Many see HIEs as critical to the success of an ACO. HIEs can help with some clinical data and physician referral patterns. However, HIEs are not a viable source for membership/enrollment data (e.g. for patient onboarding), patient consent, and also behavioral data (such as exercise, missed doctor appointments, etc.) which, though not clinical in nature, is still crucial for managing a patient’s overall welfare.

It is also important to remember that an ACO is not only about clinical data. We often see health systems overlook 7 of the 33 CMS ACO quality measures for survey based patient/caregiver experience. These non-clinical metrics are easily tracked and available in CRM.

Another external data consideration is the patient-sponsored health record. Yes, we’ve heard the physicians who don’t trust patient sponsored data. But the quality of patient-sponsored data is already improving with technological improvements such as automated wireless home health devices, pharmacy integration, and other new technologies. This is all data that we are currently able to capture in CRM, and this data makes a world of difference in managing the whole patient.

While the internal data sourcing needs would seem less challenging than meeting external data needs, this is not always the case. Often, skillfully acquiring internal data largely depends on the health providers’ previous data warehousing investments in clinical data aggregation of hospital data and ambulatory data. Another key data quality consideration is the disparity of EMR/EPM systems from past and future hospital/practice acquisitions. It’s important that CRM integrates with a broad array of data sources. And getting this data related back to the patient to augment a patient-centric approach is a core strength of CRM.

ACOs require plenty of IT heavy lifting. Data warehousing and interoperability will always require upfront investment and ongoing attention. When it comes to IT system features and functions to coordinate care, it’s a good thing the patient-centered approach need not be created from scratch. Tribridge has custom designed a CRM solution to address all ACO needs so IT can ensure that managing Accountable Care Organizations is neither a distraction nor an administrative nightmare.

If you have questions on using CRM for your accountable care initiatives or are interested in ways that Tribridge can help with healthcare issues you’re currently facing, please contact us. We’re here for you!

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