The IT-Enabled ACO
An Accountable Care Organization (ACO) is defined as a group of healthcare providers that partner under a payment and delivery reform model. These partners become collectively accountable for the full continuum of care for a population of patients similar to the organizational design of Kaiser Permanente and Healthcare Partners Medical Group. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. Based on recent CMS draft ACO regulations, there is a wide gap between ACO and the healthcare models of today. There are a number of organizational roles that need to be defined, operating and legal agreements that need to be created, and rules for operation and security provisions that need to be implemented. These activities will take significant time and investment. However, these activities alone will not be the most critical investments that organizations will need to consider as they move down the path toward ACO.
The ACO model presents a shift towards bringing partners together. Until now, there has been limited information exchange among the many partners in the ACO model. This unique partnership creates some very interesting needs and uncharted territories that could conflict with the partners pre-existing notions or solution desires. As such, the most significant investment for ACO is the IT infrastructure, architecture, and supporting solutions that will be required to make the ACO operational and enabled to achieve the goals and initiatives that have been agreed to by partners. Unlike other mission critical components of ACO, IT has been a weak point within the healthcare marketplace. As a result, the length of time to design, build, install, test, implement, and train to become a meaningful user has a longer lead time.
Technology as a Core Competency of ACO
When considering an ACO approach, organizations need to give focused attention to the IT strategies, appropriate architectures, and roadmaps they will use to move from desired state to reality. This will help ACO partners to discuss and agree to an overall approach while also creating the organization and business operations that will be enabled as part of this overall solution approach. Important components of ACO technology include:
Increased Data Exchange in Health Communities
Fragmented data across healthcare communities leads to increased cost and decreased patient experience. The ability to exchange clinical information will be critical to ACO success. Beyond the important aspects of delivering quality care, there are real business drivers that favor an environment where clinical and cost information are combined into a comprehensive system delivery model. The Enterprise HIE eco-system is one approach that innovative healthcare systems are using to enable them to connect patients and physicians together in a more collaborative environment.
Where does the data sit and how does it get analyzed?
A proper Interoperability solution will help partners connect into one digital nervous system. Once this data is in place, it can be appropriately analyzed and reported according to core measures and other quality outcomes under this new reimbursement model using Business Intelligence and data analytics. Within the HIE, Business Intelligence makes it possible to analyze a patient population to study a disease state, such as diabetes, through clinical studies of this narrow geography. The ACO then has the ability to handle care issues across the geography and the public health questions that result.
Increased Collaboration Among Patients, Physicians, and Healthcare Communities
Enabling patients and physicians into the design of care increases the financial effectiveness of an ACO, and there are many smart options available to invite collaboration. Healthcare portals can be used to empower patients by providing meaningful access to their care and connect a patient to the entire health system that impacts their care. Similarly, community portals can be created to connect patients to those with similar disease states for information sharing, support, and advice. This empowers patients to work with ACOs in creating cost saving, and patient centric, clinical care. Organizations can also use physician portals to connect physicians to the critical components of clinical care which can then be incorporated into executive decision making. This would enable stakeholders of a healthcare system to come together to create better services and relationships within the community that they serve and increase an ACO's success as a result.