With the announcement of the proposed rule on accountable care organization (ACO) development that was published by the Department of Health and Human Services on March 31, the Falls Church, Va.-based CSC released a report describing six success factors and HIT solutions ACO organizations need to considering when achieving operational goals. The report, entitled “Health Information Requirements for Accountable Care,” recognizes that ACOs will evolve along different paths, some from integrated delivery networks (IDNs), some from independent physician associations (IPAs), or some from multi-stakeholder health information exchanges (HIEs), but all ACOs will require similar HIT underpinnings. The critical HIT factors for ACOs that CSC has laid out are as follows:
- ACO Member Engagement
Because the proposed rule states that patients have the choice to go outside the ACO for care, the ACO therefore must utilize patient engagement tools to create customer “stickiness,” or a way to tie them to the ACO, according to CSC. ACOs will have to provide for patient-provider communication and participation throughout the continuum of care via patient portals. The portals must provide access to clinical functions like secure messaging, reminders, alerts, test results views, and prescription refill requests, yet also be able to “support administrative and financial tasks including access to registration, appointment scheduling, messaging and other systems that make it easier for members to access.” Portals must also provide for real-time chat capabilities, as well as be connected to remote patient monitoring tools.
- Cross Continuum Medical Management
The CSC report states that the “gold standard for ACOs” will be the management of episodes of care and transitions of care for patients. Underlying the management of care is EHR implementation, and CSC recommends several additional layers: online guidelines and protocols like look-up features and charting templates; physician messaging modules; consistent clinical decision support (CDS) rules; and consistent clinical content across venues of care. “I think the one area that has the most to be done is care coordination and that’s from a data perspective, as well as a process and operational perspective,” says Christine Stead, a principal in CSC’s Emerging Practices Group, which is based in Waltham, Mass. “That category of IT infrastructure lines up nicely with the work that needs to be done on the health delivery side, trying to innovate and do a better job with patient-centered medical home or team-based consultation models or sharing information and providing care in a team-based structure in some way that’s unique to what we’re doing now and is incented appropriately.”
- Clinical Information Exchange
CSC notes the fundamental question with HIEs is how to provide access to information, either by implementing a private network or by using a public network as RHIOs or statewide exchanges do. “I think in terms of infrastructure requirements that the entry fee to get into this game effectively is going to be the ability to share clinical information in a meaningful way across the continuum of care,” says Jordan Battani, another principal Emerging Practices. “And without that in place, I think it will be very challenging to do any of the other activities, whether it be the care management and all of the other patient engagement things you have to do to meet these new federal standards.”