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.”
- Quality Reporting
ACOs must also provide real-time quality reporting to be delivered through “dashboard” or “desktop” reports that contain graphical summaries of important information, as well as flashing icons that indicate abnormal results. The challenge will be maintaining this reporting over the ACO sites that have separate EMRs. This is where HIEs and data warehouses are instrumental in maintaining the information across the venues of care. “Right now our data usually sits in several different systems,” Stead says. “That means the clinical, the financial, the administrative, and the research data can all come together to not only manage the care of the population better,” but also feed evidence based care guidelines and comparative effectiveness research.
- Business Intelligence, Predictive Modeling and Analytics
Beyond maintaining the patient’s clinical data across the continuum of care, the patient population must be analyzed for broader public health goals. CSC notes that multiple vendors will be necessary to achieve this complex step and will require significant configuration and integration with the ACO’s preexisting systems. Stead recommends ACOs have a few skill sets onboard including an experienced system integrator to link disparate systems, an epidemiologist to understand the intricacies of population health, an actuary for the payer perspective, and an analytics specialist to synthesize data from different data warehouses. Battani says these skill sets will help “especially early on as you’re starting to assess the population that you’re defining in your accountable care organization, but also to manage those going forward and looking for trends.”
- ACO Risk and Revenue Cycle Management
CSC notes that ACOs will have to adopt similar management systems as health plans’ membership repositories to properly identify, monitor, and report the financial and administrative processes of its population. The ability “to recognize and capture information before, during, and after the period when individuals become patients” is important CSC says. These data will also be necessary to assess provider productivity and population utilization of services. “I think [healthcare organizations] need to think about partnerships and collaborations that can help bridge the capital gap, instead of everyone building everything themselves, and what can they partner with effectively around data integration and collaboration,” Stead says.