While the federal Centers for Medicare & Medicaid Services (CMS) unveiled the proposed rule for accountable care organizations (ACOs) on March 31, numerous patient care organizations have already been developing ACO-type arrangements in the commercial health insurance sphere. The steps being taken to begin coordinated care initiatives range across a spectrum from very preliminary work to some more advanced models (while some medical groups have already done work with CMS through its earlier ACO demonstration project).
One medical group executive who has had some preliminary experience with working to coordinate care, and with leveraging clinical IT in that effort, is Kersten Kraft, CEO of the Santa Clara County Independent Practice Association (SSCIPA), which is comprised of over 800 physicians (just under 300 of them primary care physicians), and is based in San Jose, Calif., while serving the entirety of Santa Clara County. SSCIPA is an affiliate of Stanford Hospital & Clinics in Palo Alto.
Under Kraft’s leadership, SSCIPA has moved forward into a variety of contracting initiatives; and in tandem with those efforts, his organization has moved forward in the clinical IT sphere as well. Kraft—who in addition to leading his organization as its CEO, continues in practice as a urologist—spoke with HCI Editor-in-Chief Mark Hagland earlier this spring, shortly before the proposed rule on ACOs was released. Below are excerpts from that interview.
Tell us about your organization’s experience in leveraging clinical information systems to support care coordination.
Like many IPAs, as our organization grew and had more contracts, and with the need for care data, we ended up developing our own software, which we call Access Express. It was an in-house-developed software that became popular enough internally that we decided it could be used by others; so Hill Physicians in Northern California, and NAMM (North American Medical Management) in Southern California, and Monarch, have all used it. It was not a medical record; it was basically for authorizations.
So when it came time to implement an EMR, we looked around, and found a software program in the U.K. that was built on the same platform as our software, and could be integrated. It started out as clinical information-gathering by an anesthesiologist who had trouble getting pre-op information on his patients, and went on to be a chronic care product in the U.K. They had no need for the patient coordination part, because they have a single-payer system. So a little over a year-and-a-half ago, we met with them and agreed we would use their software, and integrate it into a complete package and distribute it in the U.S. The integrated package we call Access Express 5.0; their software is called Exelicare, and the company is called AxSys Technology, Ltd., and the company is based in Glasgow, Scotland. Their only real venture outside the U.K. is as the provider for a chronic care software in Ontario.
Kersten Kraft, M.D.
When did you go live with the EMR solution from AxSys?
The EMR part went live on some beta sites in October, but in terms of being truly functional, the go-live was in November. Everybody has been introduced to it, and all the physician offices are using it for patient office visits, radiology, and pharmacy data.
What are your plans in the ACO arena?
As we’ve looked the ACO world, it’s been clear to us that nobody knows what the concept—in its various public and commercial forms—is actually going to look like two or four years from now. We’ve been solicited to do a project for Blue Shield of California for CalPERS [the Sacramento-based California Public Employees’ Retirement System], with O’Connor Hospital here [in San Jose]. But what we think is going to happen is that the amalgamations will be broader than that. So our core goal is to have all our core hospitals involved with us, however these ACOs come down to us, whether by the insurers or employers.
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