Accountable Care Organizations
ACO rule has big implications for IT
New population health tools needed to effectively manage ACOs. By Ron Parton and Subbu Ravi
he Centers for Medicare & Medicaid Services’ (CMS) fi nal rule on accountable care organiza- tions (ACOs) includes 33 measures on overall performance while allowing providers options on shared savings. While the new ACO rule is likely to persuade payers and providers to provide better quality at a lesser cost, it now draws focus on a greater need for new population health information technology to support ACOs.
Current reporting technology and electronic health records (EHRs) may be able to provide basic reporting on the measures, but they are woefully inadequate at meeting the ACO requirements for improving care, enhancing the patient experience and reducing costs. Health information exchanges may pro- vide continuity of care records for pa-
Ron Parton, M.D., is chief medical offi cer, and Subbu Ravi is vice president of solutions, Symphony Corporation. For more on Symphony Corporation: www. rsleads.com/204ht-202
tients at the point of care, but they do not integrate care plans, document interventions, support task management or measure outcomes. New population and care manage- ment systems will be required to support primary care medical home models, care coordination, case management and transitions of care. Advanced healthcare delivery will require the adoption of new information systems and tools that: • Provide rapid, fl exible and continuous performance reporting; • Promote the proactive identifi cation and management of the “highest risk” patients; • Accurately attribute patients to physicians and care teams;
• Allow care teams to coordinate care across the en- tire continuum and systematically manage multiple
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chronic illnesses through use of a common care plan – clinical integration;
• Integrate information and workfl ows across EHRs, care teams, providers, community resources and health information exchanges (HIEs); • Support real-time decision making and population surveillance using evidence-based guidelines; • Engage, educate and support patients in self-care, prescription drug adherence, lifestyle improvement and prevention; and
• Aggregate and manage data from multiple disparate data sources (clinical, administrative and fi nancial) with reliable master patient index functionality.
Data warehouse/data repository
It is important to be able to integrate multiple data sources, including ambulatory and inpatient EHRs, labs, scheduling, billing, health information exchanges (HIEs), insurance claims, remote monitoring, patient self-reports, research, demographic, administrative and fi nancial data. In general, the data warehouses that are included with EHRs are not designed for integrating fi nancial, clinical, research and administrative data from multiple external sources or for use in tracking healthcare interventions and outcomes for populations. To improve and report on perfor- mance, an ACO will need to create a data warehouse and/ or repository to store all available data on its patients and services and make this data available across the enterprise to support population and care management initiatives.
Population health and care management system A population health and care management system should include an enterprise multi-disease registry with measures and reporting; workfl ow support and tools for case management and health coaching; care team performance
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