SEPTEMBER 24, 2014 (eHealth Initiative) – Recent reforms are driving a sea change toward a value-based, coordinated care paradigm that incentivizes health providers based on the quality and health of a population, not quantity of care delivered across the continuum. New payment and delivery models such as accountable care organizations (ACOs) are being implemented across the country to improve the value of care. In shifting shared risk and responsibility from payers to health providers directly, ACOs strive to achieve the Triple Aim of better care, better outcomes and better costs. Since the Centers for Medicare & Medicaid Services (CMS) initially rolled out ACO programs in 2011, a wide range of ACO models have proliferated in Medicare and Medicaid programs, as well as among commercial payers and employers. While they vary in approach, size and complexity, ACOs are fundamentally redesigning the healthcare delivery system.
Because ACO partnerships often integrate providers, specialists and systems across disparate settings into a unified network, they must effectively coordinate care to manage health and risk both at an individual and population level. A robust health information technology (health IT) infrastructure allows ACOs to derive actionable value out of information collected from various data sources to build a complete, secure and up-to-date record of a patient’s health and medical history that is easily accessible, shared, and updated over time. ACOs also often depend upon clinical, claims, financial, and administrative data to continuously measure, monitor, analyze, and improve clinician performance and patient outcomes. At individual patient levels, health IT can enable care providers within an ACO to work in concert to capture and act upon data as a patient consults primary care physicians or specialists, receives tests and treatments, fills prescriptions, and returns home for post-discharge monitoring. By combining and analyzing data, ACOs can measure and compare their internal metrics with nationally recognized best practices, standards, and evidence-based guidelines to improve the quality of care across the continuum. At the aggregate level, data can be used for clinical decision support, risk stratification, and predictive modeling to support analytic efforts targeting quality, safety, efficiency, cost, and utilization of care.
The field of accountable care is still relatively nascent, and ACOs are taking a variety of approaches to developing, deploying and expanding health IT capabilities. It is, therefore, important to understand the health IT assets that are needed to improve coordination and convenience. In July and August of 2014, eHealth Initiative (eHI) and Premier, Inc. fielded an online survey of ACOs to determine the current capabilities and challenges of health IT implementation across the country. Responses were received from 62 organizations, including members of Premier’s Partnership for Care Transformation (PACTTM) Population Health Collaborative.
The interoperability problem: Why ACOs can’t share data.