A Brave New World of Connectivity, Part 2

Last week Keith Figlioli, senior vice president of healthcare informatics at the Charlotte, N.C.-based health alliance Premier, Inc., spoke with HCI Associate Editor Jennifer Prestigiacomo about Premier's new initiative to help its member hospitals integrate and strategically leverage their performance data to succeed under healthcare reform. In part two of that interview, Figlioli discussed Premier’s new Accountable Care Organization (ACO) Collaboratives program and its active role in policy reform.

Healthcare Informatics: Premier also recently launched a pair of Accountable Care Organization (ACO)Collaboratives. Please offer some insights on these projects. What role will IT play within these projects and how will CIOs be involved?

Keith Figlioli: We have a rich history in doing what we call broad-scale alliance colllaboratives going back to the first pay-for-performance collaborative that we worked with CMS (Centers for Medicare & Medicaid Services) on, which was called HQID (Hospital Quality Incentive Demonstration). Over the last three years we’ve been working on QUEST, which is a systematic performance improvement at the inpatient level.

With the clause in recent legislation reform about Accountable Care Organizations going into effect in 2012, we’re now moving forward on our new ACO collaborative specifically timed with that reform to get our members ready for 2012. We have two different forms of this collaborative, one is “implementation,” which we view as the trailblazers, which shape the best practices, and the other is “readiness,” which will shadow the other group to find out where they are in the overall assessment and how they can become a part of an ACO. Really what this is about is having these providers take control of their various communities to be in partnership with their IPAs (independent practice association) and physicians in their community. We have about seven or eight interchangeable workgroups driving what the overall construct will be, one of which is specific to IT, our population and [the] health IT data management [group]. We have 19 CIOs helping to design these ACO requirements. When you think about all the systems that come into place with hospitals or physician practices today, it’s very departmentally centric, not patient-centric. But once you flip the switch to start driving toward an accountable care framework, you can really start thinking about the overall health of the population and you really need to understand the data that is flowing throughout that community to change the care process.

HCI: How will Premier work to build standardization for health information exchanges? How will you address sustainability and state by state differences?

Figlioli: By the nature of the alliance, we will work with our member CIOs to publish best practices guidelines as we did for meaningful use. My sense is there will be many levels of HIEs: proprietary HIEs for provider organizations, regional, state and NIHN [national health information network] HIEs. I think we’re going to let that play out a bit, then we’ll probably create some HIE best practices guidelines.

HCI: Premier is very active in D.C. with healthcare legislation. What are your thoughts on the American Recovery and Reinvestment Act /Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, and meaningful use?

Figlioli: One of the things we’ve done actively is get all the feedback of member CIOs and have built up an HIT collaborative. We used that as a communication platform to align our members’ voices and put various feedback mechanisms into place in Washington. A lot of it was around flexibility. Most everyone thought it [ARRA-HITECH] was a very “all or nothing” type of ruling in terms of if you’re going to get money or not once you’ve passed all the different components of it. [Another thought from the group was] the CPOE [computerized physician order entry] component was a bit aggressive, and finally we had similar commentary to a lot of groups that you count the physician in terms of credit, whether their practicing in an acute facility or not. I think it’s a lot of the same commentary of a lot of folks, but we’re aligning 2,300 different hospitals to voice that in one piece of paper. Secondary to that, we did work with an organization on these best practice guidelines, which today is only available to our member base. It’s been an invaluable guideline that folks have downloaded from us, as they think about rolling out their EMR.