The Commonwealth Fund published a report (see below) in May 2018, describing OneCare’s use of technology to coordinate care between various community providers such as social workers, mental health counselors, and nurses.
“To identify Medicaid beneficiaries who may need support, OneCare analysts aggregate demographic information, data from the medical records of physicians and hospitals, and claims data supplied by Vermont’s Medicaid agency. They analyze the data using a risk prediction algorithm licensed through Johns Hopkins University that categorizes each Medicaid beneficiary into one of four groups based on their predicted morbidity over the next year” (page 4/18).
Conducting risk-based care coordination in a comprehensive and integrated manner across the state requires complete, interoperable (i.e. shareable across multiple, diverse user interfaces), and real-time clinical data. However, the ACO’s clinical and claims data collection and management demonstrate fundamental operational flaws.