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● Roundup: ACOs

Accountable care organizations help to coordinate care

T e goal of ACOs is to avoid duplication of services, prevent errors and reduce costs, experts say. By Phil Colpas

T e Centers for Medicare & Medicaid Services (CMS) states one in four Americans – and two out of three over the age of 65 – has multiple chronic conditions. T ese account for 93 percent of Medicare’s fee-for-service expenditures, and eff orts to better coordinate their care were the impetus for the Department of Health and Human Services (HHS) to lay the framework for accountable care organizations (ACOs) on March 31, 2011. According to CMS, “ACOs are groups of doctors, hospitals and other healthcare providers who come together voluntarily to give coordinated, high-quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, espe- cially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending healthcare dollars more wisely, it will share in the savings it achieves for the Medicare program.” Healthcare.gov states that, each year, one in seven Medicare patients admitted to a hospital has been subject to a harmful medical mistake in the course of his or her care. And nearly one in fi ve Medicare patients discharged from the hospital is readmitted within 30 days – a readmission many patients could have avoided if their care outside the hospital had been aggressive and better coordinated.

“T is is one of the most exciting and important elements

of the Aff ordable Care Act when we think about the goal of transforming American medicine into the kind of care that we want for ourselves and our loved ones,” says Don Berwick, former CMS administrator and one of the architects of ACOs. “American medicine is fragmented right now – you get lost in the slats – because we built the system that way, we pay for it that way, we train for it that way and institutes manage themselves separately. T at’s not what patients need. We want continuity and seamlessness.” Berwick is often credited with coining the term “Triple

Aim,” which refers to establishing better health and better care at a lower cost. He says components of an ACO should

include: 1. Building more cooperation; 2. Investing in care coordination; 3. Adopting electronic records; and 4. Working to keep people out of hospitals.

“We don’t want them skimping on care,” Berwick says.

“T e ACO has 33 measures of care we’re going to watch very closely.” According to an analysis of the proposed regulation for

ACOs, Medicare could potentially save $960 million over three years. Here’s what out experts had to say on the topic.

Oleg Bess, M.D., founder and CEO, 4medica

MPIs help ACOs avoid population identity crises Individual identity is critical in an accountable care organi- zation. As if tracking a single patient within a hospital wasn’t hard enough, in an ACO, “individual” doesn’t always mean patient, and hospitals are part of much larger care continuums.

6 July 2013

Big organizations generate and manage big data to deliver the right point-of-service care to the right patients in the right care setting. Doing that reliably calls for bringing big data down to the level of individual patient information, where it can help drive better quality of care and validate it for optimum reimbursement. Master patient indexes (MPIs) are the traditional solution to matching patients with their information. As the link that tracks an individual’s activity within an organization and across the continuum of care, the MPI is an even more

HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com

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