CASE STUDIES CHAPTER 8

1. Create a strategy to leverage the knowledge base of the practice against the value of knowledge within the developing ACOs.
More often than not, physicians will respond to change in clinical practice with skepticism, despite research and clinical studies that prove a concept to be beneficial. The findings of Marjorie’s management team forecasted a 10-20 percent savings, which would definitely be supported by the accounting department. The alternatives that were discussed in Marjorie’s brainstorming sessions would all seem to be good ideas that would add value in order to satisfy Federal mandates. Tapping into the behavioral health expertise of all the participants in an ACO is one of the many reasons ACOs
Is it based on intuition, collective judgment (experience), or statistical analysis?
Scientific evidence can be provided to justify the use of this information (age, comorbidities, and length of time). Predictive modeling software has come a long way since this book was published. Medical artificial intelligence includes complex algorithms that are based on not only scientific and clinical research, but also statistical analysis of indicators over a certain period of time. These indicators can often shift or change over a period of time, and the software bases its calculations off of a set of clinical data extracted from multiple sources within an organization over a period of time and modeled using discreet event, agent-based, and system dynamics modeling, including information that may seem irrelevant such as the time of year, how often the patient calls in to inquire about the status of a prescription refill, or has a question about their treatment plan, etc. but actually has an impact on the results of the forecast.
3. How can information on high-risk patients be brought to the point of clinical decision making to guide physicians?
More education efforts can be utilized to directly target these high risk/high cost patients. There could be additional efforts such as assigning private duty nurses to tend to the specific needs of these patients. Additional resources such as links to a patient portal, an educational series of videos or presentations could