Module 3
The Data and Analytics Stack
The data an ACO receives and must add, turning it into a ranked list of opportunities, and monitoring performance against a lagging benchmark.
By the end of this module, you will be able to:
- Describe what claims data reveals that an ACO's own records cannot
- Prioritize a population by impactability rather than by cost alone
- Monitor in-year performance using runout-adjusted estimates rather than paid claims
- The Data You Get and Need An ACO runs on data it has to assemble from several sources. This lesson inventories what a Medicare ACO receives and what it must add. About 4 min
- Risk Stratification and Finding Opportunity Data only matters if it points to action. This lesson covers how an ACO turns its data into a ranked list of where to intervene. About 5 min
- Performance Monitoring An ACO has to know how it is doing before the year is settled. This lesson covers tracking spending against the benchmark in near-real time, and its limits. About 4 min
Module quiz
Answer all questions to see your score.
1. What is the distinctive value of the Medicare claims data an ACO receives?
Claims follow the patient across settings, revealing out-of-network utilization the ACO's own EHR cannot see, at the cost of lag and clinical thinness.
2. Which patients are often the highest-value target for ACO care management?
The already-high-cost tier partly regresses to the mean on its own; the rising-risk middle is where intervention can still bend the curve.
3. Why can an ACO not know its true in-year performance against the benchmark?
The claims lag means in-year numbers are incomplete; good ACOs steer on completion-factor and IBNR estimates, then settle at reconciliation.