Strategizing on IT for ACO Development

Within the past year, member organization leaders and executives at Premier Inc., the Charlotte-based healthcare provider alliance, have been strategizing forward on accountable care organizations (ACOs). Within that broad initiative has been a strong effort to sort through the information technology elements that will be foundational to the development of ACOs on the part of hospitals, medical groups, and health systems nationwide.As part of that effort, experts from 28 of the nation’s leading health systems have developed an industry standard technology capability model for analyzing accountable care capability. In fact, the members of the Population Health and Data Management Workgroup have just developed a new schematic that lays out the stages and elements of ACO-driven IT capability development. It is called the “Premier Continuous Care Capability Maturity Model”, and its developers consciously modeled its five stages—labeled using the terms (in ascending order of sophistication) “transaction,” “interaction,” “integration,” “collaboration,” and “transformation”—on the very well-known seven-stage schematic for EMR development created several years ago by HIMSS Analytics—but this time applied, of course, to ACO foundational IT.The announcement on Friday, February 18 of the public unveiling of this effort, and of the schematic, is one that Premier’s volunteer and executive leaders hope will move the healthcare industry forward in this critical, healthcare reform-driven area. In that context, HCI Editor-in-Chief Mark Hagland spoke last week to Keith Figlioli, vice president of health care informatics, and Randy Thomas, vice president, product strategy and planning, at Premier. Below are excerpts from that interview.Healthcare Informatics: Tell us about the basics of your ACO initiative, and the IT elements involved.Keith Figlioli: We’ve got a whole workgroup around population health and data management. And the data is the key. The goal here is enhancing the capability to access and use your data, and to move towards greater transparency. At Premier, we have an overall ACO collaborative; and the schematic came out of the Population Health and Data Management Workgroup. And the charge for this group has been, how do we put together this model? And we looked at the HIMSS Analytics EMR schematic, and put the charge to the group to put together to create something similar for ACOs. If you think about meaningful use, everybody’s trying to figure out how to strategize forward.When it comes to laying the foundation for ACO success, there are really three main layers: baseline infrastructure needs; the transactional layer; and the business intelligence and population analytics side. We put together 17 CIOs, and the schematic emerged from their work.Things are evolving forward in terms of ACO development, and we’re looking at this as an iterative process. So this schematic really is our baseline that we’re putting out into the marketplace, and we will iterate as we go along here.

Keith FiglioliHCI: What has the dialogue been like among members of the workgroup?Figlioli: I think everybody involved in this ACO area is looking for answers. And we think about how long it took just to get the consensus on how to go forward on EMRs. And I think it’s a very similar analogy to what’s happening in the ACO market on all fronts. Specific to the CIO, they’re getting the message from higher-ups that they have to facilitate this work; but they need clarity about what the phenomenon is. We’re talking to some folks who want to move forward on the ACO front but who aren’t even stable yet in terms of EMR development.So part of the creation of this model has to do with helping people with baseline issues. For example, if you don’t have a standard EMPI [enterprise master-patient index] across all your systems, don’t even think about ACOs. And in terms of HIE [health information exchange], there are multiple layers to what that means. There’s one layer specifically proprietary to your provider, so that you first have to simply get your own house in order, before you can go regional. And what we’re trying to do with ACOs is what we’ve tried to do with all our broad initiatives, and that is to really help our membership base get ahead of the curve in terms of the regulatory environment these days and overall in the industry.Randy Thomas: And CIOs know they’re going to have to be dealing with data sets that they don’t have to deal with today—particularly the connectivity with physicians and with the whole payer side of the equation. And how do you do the types of business modeling and clinical performance measurement, and so on? We’re hearing from the CIOs asking us to help them figure this out. It’s hard enough in the acute-care space, but beyond that, in the non-acute space, the fragmentation is just extreme. And that’s why we’re working with IBM to collaborate on analytics. That’s the kind of work that ACOs will require.

Randy ThomasFiglioli: So to sum up, what we’re really trying to drive towards is, what is the road map forward, and how do we do that best as an alliance, in terms of the consensus around what we’re hearing from around the country?HCI: What’s your advice for CIOs in all this?Figlioli: The question is, what is the critical path, per your strategic priorities, based on where you are right now? Where are you on meaningful use? If you look at the statistics, things aren’t where they might be. But the progressive providers, especially on the meaningful use side, are ones where the board and the senior management are strategically engaged; and in terms of this, I think the folks who are already ahead on meaningful use—a handful of very progressive, large IDNs—are the ones able to jump all over this ACO phenomenon; whereas you’ve got a whole lot of people just struggling with the baseline stuff.Thomas: And one of the elements in this maturity is that you’ve got to have your transaction level set, get your own house in order, get an enterprise-wide EMPI, get your EHR totally in order, before you even begin to start thinking about the rest of this stuff.