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Practice Management

The accountable care delivery model

Using technology to change provider and patient behaviors. By Charles W. Jarvis, FACHE


ealthcare delivery models are undergoing fun- damental transformation, with collaborative- care programs emerging as an alternative to the current fee-for-service model. This evolution is driving medical providers to coordinate their care more effectively through a discipline known as the patient-cen- tered medical home (PCMH), where each patient’s care design has unique goals and health improvement targets known as health outcomes. The concept of community-based collaborative care, dubbed an accountable care organization (ACO), and the PCMH are introduced in the HITECH section of the American Recovery and Reinvestment Act of 2009 (ARRA). In a broad sense, the PCMH, with its emphasis on placing patients at the nucleus of all care decisions, is actually a prelude to fully “accountable” care. The country indeed is poised to create more effective healthcare deliv- ery if these care models can be implemented effectively. However, fi xing the suboptimal healthcare system cur- rently in effect will require total reform of reimbursement policies and major reform of healthcare delivery mecha- nisms. Focus must be shifted from acute, episodic care to more preventive wellness care, with more patient respon- sibility and provider care coordination at the helm. Achieving such a high degree of synchronization and accountability is dependent on the industry’s ability to enable a more robust fl ow of health information. That is why the electronic health record (EHR) has become such a central component of these efforts. But the EHR alone, if used merely as an electronic version of the paper patient record, is not enough. Transforming healthcare into an integrated, patient-cen- tered and accountable care model requires that the EHR be used not just to automate data, but to fundamentally change provider and patient behaviors.

Paving the road ahead

Healthcare today is somewhat analogous to automobile travel prior to the development of the interstate highway system. People could move about on local roadways, but

22 April 2011

the process was not always terribly effi cient. The path between two points often required a slow, circuitous route instead of a fast and straight one.

So it is with the healthcare delivery system today. Highly trained medical providers effectively care for patients and create accurate and complete patient records within healthcare organizations. They improve care locally in much the same way that the fi rst automobiles traversed neighborhood roads slowly and carefully within communi- ties. The introduction of the EHR in these care settings has made information fl ow even more effective, much like newer automobiles could travel faster and safer down neighborhood roads. Truly accountable, patient-centered care starts with the ability to exchange standards-based data, allowing all pa- tients and healthcare organizations to easily communicate with one another much like the fi rst, disjointed interstate highway system allowed faster, safer automobiles to travel more quickly between two points. Two existing continuity- of-care standards – the continuity-of-care record (CCR) and the continuity-of-care document (CCD) – are steps in this direction. Hopefully, within a few years the industry will choose a single standard to embrace. Standards will make it easier to link EHRs together, but EHRs still must be connected in ways that will allow the most useful fl ow of health information coordinated around the individual patient and community. This is where the health information exchange (HIE) plays a critical role. The combination of EHRs and HIEs will effectively move health data from point to point, and from the patient to the broader community. It will disseminate the population health information needed for accountable care to achieve its goal of a more effective healthcare delivery system. Yet it is crucial not to overlook one important difference between roadways and healthcare: the inherent individu- ality of healthcare. While use of multiple EHR systems requires standards-based data interoperability, providers must go farther in order to fully maximize the effi ciency of their delivery processes, enable complete collaboration and enhance patient care outcomes with measurable results.


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