For health care groups transitioning to an Accountable Care Organization (ACO), or preparing to become an ACO, there are key goals that should be achieved:
To succeed as an ACO, participating organizations should also strengthen the core competencies that will be necessary, such as:
This means having mechanisms in place to enable strong patient engagement, primary care redesign, a coordinated care network across different settings and provider organizations. This also includes identifying and managing high-risk patients experiencing poor quality and high-cost outcomes, quality measurement, and ongoing feedback and reporting.
ACOs should be able to illustrate the meaningful use of a certified Electronic Medical Record (EMR) system and update, integrate, and maintain clinical and financial data across clinical partners and from multiple sources. Accountable Care Organizations also need financial data systems that are sufficient for assessing and managing financial risk, and are integrated with clinical data systems.
Being well-equipped to take on financial risk means having appropriate provider contracting and payment methods in place, being able to assess and manage financial risk, possessing the capital resources to assume risk and having the ability to distribute payment.2
A strong ACO demands a successful coordinated care network. And the backbone to any smoothly operating coordinated care network is a strong health care information technology (HIT) platform and electronic medical records (EMR) system.
Why? Because data ties into every aspect of ACOs, from collecting patient information and categorizing high-risk patients, to tracking population health improvements. Having a truly effective, sustainable HIT solution must extend beyond just data reporting analysis—today’s demands ultimately require actionable insight into an organization’s financial performance and population’s health.
This provides clear visibility across the care network as well as the ability to influence behavior—to take action—directly at the point of care. Without this, hitting revenue goals and realizing quality care outcomes can become increasingly difficult.
To meet or surpass those goals, it’s essential to judge information technology, and an EHR system, based on two principles:
While hospital-based health systems and integrated delivery systems may already have much of the HIT (or a commitment to improve the HIT) at their organization, and may possess the skill sets needed to achieve success as an ACO.
However, independent practices and specialists should find out if they are sufficiently “wired” to meaningfully participate in a coordinated care network. Is turnaround time on consultations acceptable? Can they return consults and procedure reports in electronic form, and how are they equipped to capture and demonstrate the quality of the specialty-based care provided?
1 Longworth, D.L. (September 2011.) Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Cleveland Clinic Journal of Medicine Vol. 78 9 571-582. Available at: http://ccjm.org/content/78/9/571.full.
2 Center for Medicare & Medicaid Innovation. Frequently Asked Questions (FAQs) About CMS’s 2011 Accountable Care Organization Accelerated Development Learning Sessions. Available at: https://acoregister.rti.org/index.cfm?fuseaction=dsp_faq.
