Use an HIE to leverage existing information systems.
Standard fee-for-service payment models will soon face what may be their most viable competition to date: accountable care. Established under the Patient Protection and Affordable Care Act (PPACA) of 2010, accountable care organizations (ACOs) represent integrated care systems that will be responsible for the quality and cost of the care they provide to Centers of Medicare and Medicaid Services (CMS) beneficiaries.
Early in 2012, CMS will begin contracting a limited number of ACOs to serve identified patient populations. Key to these contract awards will be a history of balancing care quality and cost effectiveness.
Because a central concept in accountable care is that all members of a patient's care team are jointly responsible for the quality and cost of care — and also share the economic gains of improved care — stakeholders considering ACO participation have much to consider.
Lead, follow or wait for a mandate
Although the scope of CMS' ACO initiative will be limited initially — and even for those early contracted entities the opportunity to benefit from shared savings will be three years down the road — commercial payers and self-insured plan sponsors that have been chasing value-based benefits for years are flocking to the ACO banner. It is likely that these payers will leverage the ACO foundation to drive value-based initiatives forward faster. This potential development, on top of the pending details of the rules governing ACOs, leaves providers faced with uncertainty.
The decision to be an early or late mover and a leading or supporting player will largely depend on a provider's size, resources and culture toward risk. Providers that act now to tackle the enormous challenges of setting up ACOs stand to gain a competitive advantage.
Building the infrastructure
The infrastructure must be able to capture and correlate a broad view of the patient to empower all members of the care team with the same, comprehensive, up-to-date view.
One approach to building the ACO infrastructure is to replace existing systems in favor of a single information system. The most practical and cost-effective path is adopting health information exchange (HIE) technology that enables ACO participants to leverage existing information systems to exchange data across care locations, facilitate care collaboration, perform quality reporting and ensure all data for fulfilling ACO objectives is captured.
The technology foundation required to adequately support an ACO includes:
• Integration across disparate applications and settings;
• A unified view of the patient across institutions;
• Continuous live updates from participating entities and alerts of such updates to ensure timely care coordination across all responsible parties;
• Disease and case-continuity process and data views tuned for care, outcomes and bundled-payment contracting;
• Management consoles that enable tracking of a patient's care across all settings for administrative decision making and reimbursement management; and
• Aggregation of population records to enable reporting on quality measures, such as follow-up frequencies, readmission rates and preventive care.
Regardless of whether ACOs take center stage or play a supporting role in the evolving healthcare landscape, one thing providers can bank on is that care-delivery reform is inevitable. Government, commercial payers and self-insured plan sponsors will implement dramatic changes to put the health system on more solid and efficient footing to reduce costs and improve patient health outcomes. Whatever shape these reforms take, a technology infrastructure that enables an end-to-end, holistic view of the business and delivery of care will play a critical role as organizations prepare for the future healthcare landscape.
James K. Lassetter
is CEO, Medicity.
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