CIOs, Industry Experts React to ACO Proposed Rule Release

Experts see multiple issues
Industry experts following the developments around the ACO concept see a number of challenges, some of which they say leaders of provider organizations may not yet even have fully considered. “The disappointing thing about the ACO rules in the proposal stage is they have created a whole new set of quality reporting requirements for health delivery organizations, and this is on top of all the reporting requirements they currently have and all the new quality reporting requirements from the new HITECH/meaningful use incentive program,” says Jordan Battani, a principal research in the Waltham, Mass.-based Emerging Practices Group, a division of the Falls Church, Va.-based CSC. “There doesn’t seem to be much cross-fertilization in all these federal programs and interests in quality, and it reads a little like a pile-on,” she adds. “It would be great if all these could be coordinated into a master set of quality indicators. At initiation, it’s going to prove to be just an incredible challenge for everybody.”

Meanwhile, patient care organization leaders need to think very carefully and thoroughly about the change management aspects underlying ACO development work, says Ron Wince, president and CEO of the Mesa, Ariz.-based Guidon Performance Solutions, a consulting firm specializing in operations management and technology consulting.

“Those organizations at the higher end of maturity on the curve in terms of understanding processes will be able to benefit that,” Wince says. “It starts with the ability to actually measure quality,” he notes. Organizations that can already do so “will be a step ahead. I always go back to the core questions of how versus what. And I think the organizations that are further along on the ‘how’ piece will be more successful on this journey.” So, for example, being able to successfully map processes such as delivery of care for coronary artery bypass graft (CABG) surgery, and to be able to use formal performance improvement methodologies to improve care quality, service quality, and efficiency around such common procedures, will be essential to success in this new environment, he says.

Wince urges CIOs to “go back and revisit your IT governance and strategy: how are you going to run IT in a very fast-paced landscape? Having an EMR will be table stakes just to get into the game,” he insists. “Second, you need to look at your technology portfolio and try to simplify it as best as you can, and to focus in on what your most capable technologies are.” Above all, he says, “Don’t chase shiny objects”—meaning, focus on what technologies can do, not simply on adding technologies for the sake of doing so.

UPMC’s Dailey says she and her colleagues are very aware of the major challenges their already advanced organization faces going forward. “The integration of all of our applications, how we make sure we have the right patient everywhere and that patient is known in our system, is a challenge; and making sure that the technology that the end-users are using is up and running,” will also be important, she adds. “Our service and our consistency and reliability of the technology must be as near to 100 percent as possible,” she notes, adding that the interfacing of different information systems will be another key to success going forward.