Health IT: The Glue for Accountable Care Organizations

Norton is using Microsoft's Amalga HIE platform and Microsoft HealthVault to mine patient data and accelerate the process of information exchange among providers and patients. By combining Amalga's capabilities and the HealthVault personal health record (PHR) with EHR deployment, Heilman says, Norton will be able to create a patient-centric view of clinical, patient-entered, and claims data that will measure how the ACO is affecting quality and efficiency. Humana's claims data, Heilman adds, will be used mainly to track where patients are going and what's being done for them outside the Norton organization.

At the same time, Norton will send clinical information, including hospital data, to patient PHRs on HealthVault. Patients can push care summaries (in the form of continuity of care documents (CCDs) or continuity of care records (CCRs) to their physicians. This will immediately give primary care doctors who don't work in the hospital more inpatient data than they have now.

Down the line, Heilman says, Norton will probably replicate its core health information system within Amalga, giving physicians who have an Amalga viewer the ability to see all inpatient data. As more doctors get their own EHRs, the Norton hospitals hope to gain online access to ambulatory care records, as well.

Using Amalga as a data warehouse, Norton will build disease registries to help manage its patient population. It will also integrate home monitoring tools with the HealthVault PHR so that clinicians can see how patients are doing at home.

Heilman doesn't envision problems in using Norton's current administrative systems to measure the cost of care in the ACO, because the only patients involved initially will be those in Norton's and Humana's own health plans, and only employed doctors will participate in the ACO. But when the ACO encompasses independent doctors, and Norton has to share ACO savings with them, he says, “that's a different scenario. Structuring that will be a little interesting and dicey.”

MOUNTAIN STATES HEALTH ALLIANCE

Mountain States Health Alliance (MSHA), a Johnson City, Tenn.-based healthcare system with eight hospitals in Tennessee and five in Virginia, is developing an ACO that will encompass the tri-city market where its facilities are located. All of MSHA's hospitals and its 250 employed physicians, as well as many of its 1,000 community doctors, will be involved in the ACO. Fortified by the lessons it has learned in the ACO collaboratives of the Premier healthcare alliance, Charlotte, N.C. (which also includes the Premier group purchasing organization), MSHA plans to launch its new organization in July, using its own employees as guinea pigs. By Jan. 1, 2012, MSHA hopes to be ready to participate in the Medicare shared-savings program.

Health IT is the “glue” on which the success of the ACO will depend, declares Morris Seligman, M.D., senior vice president and chief medical officer of MSHA. The core strategy is to use information systems to measure and manage population health. In addition, health IT will be required to improve care coordination and to supply actionable data at the point of care.