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Accountable Care: Ready, Set, Go!

October 20, 2011
by Jennifer Prestigiacomo
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The role of HIT in laying the groundwork

In preparation for the ACO final rule announcement, which is scheduled to take place at noon Thursday, CSC Corporation released a report, “Preparing for Accountable Care: The Role of Health IT in Building Capability,” earlier this month that laid out the main strategic and operational IT challenges in accountable care.

The big message of the report was that for healthcare organizations to really succeed in accountable care, they need to have a long-term goal of more than just qualifying for a Centers for Medicare & Medicaid Services (CMS) shared savings program. They needed to really change the way they deliver care. Jordan Battani, principal researcher at the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices at the Falls Church, Va.-based CSC, says fee for service is definitely going away, however, there are “40 things going to replace it,” which all require healthcare entities to be accountable for patient and population care. Organizations that fail to do that, will fail in the long run, she says.

The report points out that health information exchange (HIE) will be critical for creating an accountable care organization. Battani says that having an enterprise-wide electronic health record (EHR) while ideal, might not be a reality for many organizations, so creating an HIE will allow providers to virtually view and use the same EHR. Important to that HIE is the ability to track and conclusively identify the patient through a master person index (MPI); and when payers are involved, a master member patient index will be necessary to view insurance coverage and financial data elements. For healthcare organizations, it’s also important to conclusively identify physicians in the care continuum, Battani adds.

Patient engagement is going to be another major part of accountable care, according to the report, with providers encouraging and supporting patient self-care activities to extend the benefits of patient self-service beyond administrative and overhead tasks. As Battani says the “patient is the untapped resource.”Organizations haven’t been successful in engaging the patient, she says, so the key is to figure out the right tool for engagement and the right incentive.

Battani says that there’s more demand from providers in this particular area and CIOs are being bombarded from requests to come up with a strategy to increase patient engagement. She says that CIOs have to get really disciplined with requests, since there are so many different engagement platforms and capabilities that can be enabled. The big challenge will be to set a list of prioritization, with elements to do now and others to do later. CIOs should evaluate the necessity of all requests using a decision matrix, which will vary by organization, she says. “You can do everything under the sun,” Battani says. “But you need to prioritize for your particular organization.”

Battani says that technology is generally not what trips organizations up; it’s the “sandbox stuff” like forging agreements and governance issues that is the real challenge. Her advice for healthcare organizations, is to first to have those conversations and then plunge through working out all the thorny issues. In this new era of accountable care, there will be many challenges, but the main one Battani says will be developing a strategy that creates a priority framework to figure out the order of which IT capabilities to implement, and in which order to implement them.

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