How an ACO Improved Quality Measure Performance with Clinical Data Integration

Healthcare organizations face increasing pressure to demonstrate quality performance to payers, but accurately capturing and reporting clinical quality measures remains a significant challenge. Nebraska Health Network (NHN) tackled this challenge by integrating electronic medical records (EMRs) clinical data into Koan Health’s population health analytics solution.

By moving from manual chart reviews to automated data feeds, NHN significantly improved its quality reporting accuracy while reducing administrative burden. Their experience demonstrates how strategic data management can help healthcare networks meet diverse payer requirements and maintain high-quality performance standards.

The Quality Reporting Challenge

Traditional quality reporting is a significant burden for Accountable Care Organizations (ACOs). Manual processes, such as reviewing EMRs, documenting gap closures, and submitting reports via payer portals or fax, are labor-intensive and prone to errors. Incomplete data capture exacerbates these challenges.

Adding to the complexity is the diversity of payer requirements across Commercial, Medicare Advantage, Medicaid, and Medicare Shared Savings Program (MSSP) contracts, each with unique quality measures and reporting specifications. Meeting these varied demands requires tailored approaches, which can strain resources and increase the risk of non-compliance.

For NHN, addressing these barriers was essential to improving quality reporting and meeting the expectations of payers and providers.

Partnering to Improve Performance

NHN partnered with Koan Health to implement a streamlined clinical data integration process via its population health management solution, Datalyst^TM. This collaboration enabled NHN to establish robust data feeds that centralize information from multiple sources, including electronic medical records and claims data, into a unified population health solution.

Weekly data transmissions ensure that the platform remains up-to-date with the latest clinical and claims data, allowing for timely identification and closure of care gaps. Most payers accept this data monthly, while some opt for quarterly ingestion, resulting in significant improvements during these periods. By leveraging these technology-driven solutions, NHN has enhanced its ability to produce accurate, comprehensive quality reports tailored to each payer's unique requirements, ultimately improving its overall performance metrics and operational efficiency.

Submitting clinical data has helped us improve our quality scores. It allows us to capture things we might not have otherwise. For example, gaps like A1C control or blood pressure management wouldn’t be closed through claims alone.  By leveraging payer extracts, we’ve seen notable uplifts in performance for these measures and others, even those requiring longer look-back periods. Additionally, the data feeds have significantly reduced the manual workload for our clinical team, allowing us to focus on higher-value tasks. - Joni Cox, BSN, RN, Manager, Population Health, Nebraska Health Network

Transformative Outcomes

By leveraging automated clinical data feeds, NHN has achieved measurable, year-over-year improvements in quality scores:

• Manual chart review requirements decreased significantly, freeing clinical staff to focus on patient care rather than documentation submission.

• The integration of EMR data dramatically improved the capture of key network-wide performance metrics, particularly for measures like A1C and blood pressure control that were previously difficult to track through claims alone.

• Quarterly payer data ingestion led to better payer performance tracking, with NHN noting significant jumps in quality scores during quarters when payers processed their clinical data feeds.

• NHN consistently met the quality thresholds required for payer contracts and shared savings opportunities.

• The automated and enhanced data pipeline also provided cleaner, more current gap lists, enabling providers to conduct more targeted patient outreach and reduce unnecessary follow-up on already-closed gaps.

Integrating clinical data is essential for achieving quality goals and thriving in today’s value-based care landscape. Organizations must prioritize building a strong partnership with a population health analytics vendor, ensuring clean and comprehensive data processes, and advocating for transparency through impact reports from payers. These steps improve quality scores, strengthen payer relationships, and support long-term success. I encourage healthcare organizations to adopt similar strategies and explore partnerships to enhance their value-based care programs and drive meaningful improvements in patient outcomes. - DT Nguyen, Founder and CEO of Koan Health.

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About the Client

• NHN is the ACO for the Nebraska Methodist Health System and Nebraska Medicine.
• Network: 8 hospitals & 5,000+ providers.
• Focus: High-quality, cost-effective care transformation.