It's time for some positive news for a change.
This week's announcement that three more Pioneer Accountable Care Organizations (ACOs) are leaving the program will bring out the naysayers and cynics in droves. "The Pioneer ACO program is a failure." "CMS really messed up this one." While the news is indeed troubling, it's far from an indictment of ACOs. It's a learning process.
In fact, learning process is a good way to describe all facets of this transformation that we are witnessing in healthcare. Did Ford and co. build automobiles successfully overnight? Did Apple and IBM build the best computers, right from the start?
I don't call programs like the Pioneer ACO a failure. I call them advancing the educational process. You don't know unless you try. It's the lesson to end all lessons.
This week, I published an article about the government-funded, statewide Nevada HIE, which ceased operations earlier this year. The HIE was, to put it bluntly, a disaster. For various reasons, the stakeholders responsible for its development were behind the eight ball and couldn't get out of their own way. There was a lack of trust between the HIE board of directors and the local department of health. There was no long-term vision for the HIE until it was too late. And overall, there was poor community engagement.
Suffice to say, it wasn't a project that left a lot of people smiling at the end. However, I didn't find there to be a lot of bitterness for those involved. They looked at it as a learning process. I'm not sure they would be involved with that group of stakeholders again, but no one closed the book on HIE altogether.
Nevada HIE was funded initially through the HIE Cooperative Agreement, an Office of the National Coordinator for Health IT (ONC) program that came about after the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Like the HIE Cooperative Agreement, the Beacon Communities project had the ONC dole out grant money after HITECH to various state and regional entities to build and enhance some kind of health IT infrastructure.
We often profiled the Beacon Communities at HCI. In fact, our editorial team recognized the Crescent City and Colorado Beacon Communities with Innovator awards. Many of these Beacons oversaw some impressive projects that advanced health IT infrastructure in their own unique way. In my opinion, these people were the best of the best.
Despite this, the researchers found that the Beacon Communities, like those involved with the HIE Cooperative Agreement, stumbled upon their own slew of lessons. Recently, a group of researchers examined the methods the Beacon Communities employed in building up health IT infrastructure in their specific regions. Surprisingly, they found that even with a variance of projects done by these different Beacon Communities, the lessons were often the same.
On technical issues, many of the Beacons were forced to rely on previous collaborations to develop health IT infrastructure. For instance, in Maine, Bangor Beacon Community relied on the well-established HIE, HealthInfoNet. The Beacons also came to understand that technical support and recruitment efforts took longer than expected. Also underestimated was the time it took to prepare for a clinical data exchange and practice-based performance measurement. In one case, Cincinnati Beacon had a 10 month delay.
On governance, many of the Beacons learned to use neutral conveners to measure performance in order to gain stakeholder trust. Specifically, this was the case in the Tulsa and Keystone Beacon Communities. They also learned to deploy transparent governance structures.
On privacy, the Beacons learned to engage policymakers to ensure there were not overly restrictive policies limiting data sharing, while still ensuring protected health information (PHI) was safeguarded. Many, such as the San Diego Beacon had to work with the state in this regard.
The lessons are all outlined in the report, published in a recent issue of Generating Evidence and Methods to improve patient outcomes. I recommend it. For data sharing organizations (which is probably all of you provider groups, in some capacity), it is essential.
Remember, these were the best of the best, and they, too, had to deal with various "failures" along the way. Or--as I call them--various advancements in the educational process.
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