Pam Halvorson Identifies Challenges Facing New ACOs

The first year to 18 months of an accountable care organization (ACO) is the most challenging as data begins to trickle in of everywhere a patient went to get care, and healthcare providers typically aren't taught how to utilize that information, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

Transcript (slightly modified for readability)

What is the biggest challenge that accountable care organizations have to overcome in order to work as they are supposed to?

I think essentially the biggest problem that all the ACOs are having would be that it would be the first time in the formation of ACOs that you're actually seeing the claims data and you're seeing it across a broad spectrum, everywhere patients went, to every provider they went, anyone who is billing Medicare, for instance, or the commercial insurer. And the skillsets in the healthcare world are not to understand how to drill and manage that level of data coming in.

So your analyst becomes your best friend and you learn terms like "actuarial." Terms that normally for a healthcare provider or direct provider are words that you never would have used. So I see that as taking that first year and 18 months just to learn the nuances of how you read, look, discern, split, and find usable actionable healthcare program design, within all that data that really we've never had before.

How do accountable care organizations handle data, and how does it differ from other health delivery systems?

When you think about what you're receiving in claims, while you have internal data in a regular healthcare environment—whatever you produced, whatever you build, whatever given entity that is oftentimes within billing entities of a health system—even if you belong to the same system those basic business systems may be running separately. So aggregating that and making sense out of it was a challenge prior to things like ACOs and claims data.

Now you're going to add claims data and you're going to see everything outside of your walls. And you're going to see where and how much the names of all the providers who might have provided care to your patient and to really get a good picture of what that patient is doing. There's lots and lots of "ah-ha" moments and surprises when you begin to really understand what it is you're looking at.