Report from the National Medical Home Summit

With the Centers for Medicare & Medicaid Services (CMS) expected to issue rules for accountable care organizations (ACOs) as soon as March 23, attendees at this week’s National Medical Home Summit in Philadelphia were eager to learn more about the relationship between the medical home and ACO concepts and the information technology models underpinning them.

David Nace, M.D., vice president for clinical development at McKesson Health Solutions, said the patient-centered medical home provides a practice view and the ACO a system view of accountable care.

He reminded attendees that healthcare organizations must bring technology to bear to support team-based care and a quality improvement culture. “Health IT is the enabler that allows hospitals, nursing homes, specialists, and primary care to work together as one group, even when they come from competing organizations,” said Nace, who also co-chairs the Center for e-Health Adoption and Exchange at the Patient-Centered Primary Care Collaborative.

Nace said health IT will need to support evolving workflows, rather than cementing current fee-for-service-driven workflows in place. He was impressed by two “a-ha moments” on the part of the federal Office of the National Coordinator for Health IT (ONC). One was that modularity could become an important part of the electronic health record (EHR) market; and the second was the creation of the Direct Project to use the Internet for certain functions rather than waiting for the creation of health information exchanges. “There are something like 238 HIEs in existence working on governance structure, and only six or seven are financially sustainable yet,” he noted. “Leveraging the Web, whole regions can be clinically linked in less than a few months.”

As CMS prepares regulations for ACOs, the questions it needs to address include how the ACOs will be structured and how quality of care will be assessed. Another concern is that industry consolidation of insurers, hospitals, and physician practices could lead to monopolies.

Many hospital organizations are either forming their own ACOs or partnering with other organizations to develop them. For instance, Atlantic Health, a two-hospital system in New Jersey has formed an ACO that is expected to enroll patients by January 2012, according to Accountable Care News. The newsletter also reports that the Titusville, Fla.-based Parrish Medical Center has partnered with the Community Health Network of Florida, an integrated delivery network. They are implementing MDI’s Viewpoint Analytics (Ponte Vedra, Fl.) technology in their effort to become an ACO.

Other speakers at the summit talked about the value telehealth consultations can bring to the medical home concept. Roy Schoenberg, M.D., M.P.H., president and CEO of American Well Systems in Boston described the growth and popularity of its online system for primary care consultations. Dale Alverson, M.D., medical director of the Center for Telehealth and Cybermedicine Research at the University of New Mexico Health Sciences Center, said not only can care be better coordinated, but telemedicine and e-health can incorporate evidence-based best practices, decision support, earlier detection of a problem, and earlier intervention.

Alverson, who is also president of the American Telemedicine Association in Washington, D.C., used the example of Project ECHO (Extension for Community Healthcare Outcomes), which was developed to treat chronic and complex diseases in rural and underserved areas of New Mexico. Using telemedicine, specialists based in Albuquerque and rural providers collaborate on expanding access to hepatitis C virus treatment. “In New Mexico, we have 30,000 people with hepatitis C, and only a fraction were getting treated,” Alverson said. “Now many of them are being cured. That is a success story.”