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IT Blueprint for ACOs

February 20, 2012
by Jennifer Prestigiacomo
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Laying out the IT fundamentals and phases for accountable care

At the pre-conference ACO Symposium, “An IT Blueprint for Accountable Care,"  at HIMSS12 in Las Vegas on Sunday, Feb. 20, speakers shared with audience members a rundown of what accountable care models are shaping today’s landscape and what IT underpinnings will be necessary for these transformations.

Rob Lazerow, senior consultant, The Advisory Board Company, said that Centers for Medicare & Medicaid Services (CMS) has slew of accountable care projects available now, however, some might not be voluntary for long. He added there was a competitive advantage for early participation.
Lazerow discussed the three types of payment models for accountable care in use now:

  1. Value based purchasing- where healthcare organizations take on some percentage risk for meeting performance measures
  2. Bundled payments- attributing a single lump sum for an entire episode of care
  3. Accountable care organization (ACO)- reducing unnecessary utilization and assuming financial and actuarial risk

Lazerow mentioned that the four voluntary models of bundled payment allowed providers to enter a world of “selective accountability” to redefine the acute care episode. “For a lot of providers this is a much friendlier entrance into the accountable care pool,” said Lazaro.

Even though many barriers had been removed from the proposed ACO rule, Lazaro said, many elements have remained the same—ACOs still have to manage utilization through chronic disease management, deliver exceptional quality, and maintain transparency thought clinical quality measures (CQM). Essentially, ACOs have to become population health managers, he said. Even though CMS “fired the starting gun” with the Physician Group Practice (PGP) Demonstration, it is not exactly the “pace car,” he added. Lazerow referenced a few organizations like Providence Health & Services, Blue Shield of California, Anthem Blue Cross, UnitedHealth Group/Tucson Medical Center, whoe are embarking on innovative accountable care collaborations.

Underlying the formations of these ACO collaborations are many levels of health IT adoption. Chief among them, Lazerow said, is interconnectivity among collaborating organizations to enable information exchange, and using that information to drive performance improvement.

Dave Garets, FHIMSS, executive director, Advisory Board Company, laid out three phases of IT work necessary for accountable care and the various IT components driving them. See the table below for more information.

IT Phases for Accountable Care
IT Component Phase 1 Phase 2 Phase 3
Network Interconnectivity Support for Direct exchanges of CCDs,  Physician portal Private HIE, unified communicatiosn to track patients Community HIEs, patient connectivity, semantic interopability
Clinical Knowledge Management Inpatient and outpatient EHRS, site specific CDS to support CQM- Stage 6 or 7 CDS based on standardized, evidence, structured clinical documentation Predictive analytics, advanced CDS, CDS across care venues
Patient Activation Patient portal and PHRs, contact center to accept inbound transactions-emails Patient education tools Continuous passive monitoring of patient health status, PHRs to support wellness
Financial Operations Business intelligence capabilities for drill down reporting RCM support for new payument approaches, performance management tools for inpatient and outpatient Actuarial capabilities, RCM support for new payment approaches
Population Risk Management Dashboards, ability to capture quality metrics during care delivery process Readmission risk stratification tools,  enterprise registries Clinical risk stratification, predicition, and management; patient attribution