D.C. Report: Accountable Care Organizations on the Horizon, NHIN Testing

Accountable Care Organizations on the Horizon. While meaningful use and ICD-10 are capturing immediate attention of CIOs, there is also focus on certain key provisions of the Patient Protection and Accountable Care Act (PPACA), such as accountable care organizations (ACOs/section 3022). This shared savings program authorizes Medicare to enter into contracts with groups of physicians, hospitals, and other healthcare providers that agree to be accountable for beneficiaries assigned to them. The intent of ACOs is to bring together providers and reward them for controlling costs and improving quality. Set to begin in 2012, regulations are due out the end of this year. Characteristics of the ACO include bundled payments, partial capitation, focus on primary care (medical home), patient shared decision-making, tiered benefit design, patient engagement, and health IT.

Efforts to encourage ACOs include the Brookings-Dartmouth ACO Learning Network formed in 2009, which launched pilot implementations at the Carilion Clinic/Roanoke, Va.; Norton Health Care/Louisville, Ky.; Tucson Medical Center/ Tucson, AZ; Monarch Healthcare, Irvine, Calif.; and HealthCare Partners/ Torrance, Calif. The ACO Learning Network provides information to individuals and organizations exploring the feasibility of an ACO and supports organizations that have already begun ACO implementation.

California, according to a recent report, has 285 physician organizations with many of the characteristics attributed to an ACO. Experiences over the past 30 years provide some lessons as Medicare ventures into this area. Some of the lessons summarized in Accountable Care Organizations in California , include insights on capitation cited as effective at encouraging coordinated care, but urges that payment methods should vary depending on an organization's ability to assume risk. ACOs, warns the report, are not a panacea for healthcare spending control. And says the report, health plans, acting in concert on payment methods and performance measurement helped facilitate the growth of California's provider organizations, and should also play an integral part in fostering ACO development.

NHIN Testing and MU Timeline Subject of Standards Committee. As early as late December-early January, ONC will begin testing of clinical information exchange between healthcare providers using standards and services developed for NHIN Direct. This one-to-one sharing between providers is a preliminary step to the more rigorous sharing using an intermediary health information exchange (HIE) entity for that purpose. NHIN Direct was envisioned for use in Stage 1 as a way for providers to conduct exchange and qualify for meaningful use to receive incentive payments in the absence a developed exchange infrastructure. NHIN Direct Project Director Arien Malec updated Standards Committee members at this week’s monthly meeting. Healthcare organizations pilot-testing NHIN Direct include MedAllies/N.Y., Redwood MedNet/Calif., The Rhode Island Quality Institute, and CareSpark/Tenn.

Health IT Standards Committee MU Workgroup Chair Paul Tang, M.D., outlined ONC’s timetable regarding the Notice of Proposed Rulemaking for Stage 2 of the CMS EHR Incentive Program and explained a philosophical change on Stage 3 criteria that will be based more around performance thresholds and outcomes rather than the use of specific applications of an EHR.

The Implementation Workgroup, co-chaired by CHIME Member Liz Johnson, CIO, Tenant Healthcare and Judy Murphy, Aurora Health Care reported on plans to hold hearings in early 2010 with a broad range of witnesses involved with meeting meaningful use including RECs, the ONC Health Information Technology Resource Center (HITRC), certification (self-developed systems, EHR vendors, authorized testing and certification bodies/ATCBs ), and early adopters (large and small hospitals, IDNs, large and small physician practices ) and HIEs.