Electronic Health Reporter

Guest post by Ron Vatalaro, who works at Bisk Education with the University of South Florida Morsani College of Medicine. He writes about health informatics.

The Affordable Care Act supports healthcare providers in reducing costs and improving efficiency while delivering quality care. Accountable care organizations (ACOs) achieve these goals by enabling physicians, hospitals and other healthcare providers to create networks and share responsibility to deliver care to Medicare and other patients.

At the heart of the ACO model are three core principles:

• ACOs are provider-led organizations with a strong primary care base, and collective responsibility for quality and per capita costs.
• ACO payments are linked to improvements in quality that also reduce costs.
• Performance measures that support improvement are sophisticated and reliable, and demonstrate that savings are achieved through improvements in care.

Joining an ACO is voluntary, but the federal government encourages participation to reduce unnecessary or duplicated services, prevent errors and keep patients healthier. When providers successfully coordinate services to meet a long list of quality measures, they become eligible for bonuses.

The Current Environmment

Medicare offers several ACO programs, including the Medicare Shared Savings Program, the Advance Payment ACO Model and the Pioneer ACO Model, but many other public and private models exist. Some are sponsored by physicians groups, while nonprofit organizations, hospital systems and health insurers sponsor others. The Pioneer Model was designed for early adopters of coordinated care, and is no longer accepting new members.

To date, more than 600 public and private ACOs have formed; in 2012, the first year of the program, they generated $87.6 million in gross savings. Government support is spurring considerable growth, and ACOs could well become the dominant model in healthcare.

How Health IT Supports ACOs

ACOs are subject to certain requirements, such as demonstrating that they coordinate patient care, promote evidence-based medicine, coordinate patient care and report on their quality and cost measures. Successful reporting requires a robust health information technology framework and infrastructure, including a focused HIT roadmap to align resources with objectives to deliver quality care.

To participate in ACOs, healthcare providers must coordinate and manage episodes of care and routine care for patients that are transferred from one provider, department or facility to another. Health IT systems facilitate cross-continuum medical management through a number of practices:

• Providing access to patient records, including treatments, procedures and diagnoses, along with care summaries and general histories.
• Facilitating communication between providers, referring providers and specialists.
• Simplifying coordination and reconciliation of medications.
• Providing best practice coordination across care venues, including care plans, discharge procedures and case management.
• Enabling evidence-based care practices, such as care plans, problem lists, case and disease management, current medication lists and discharge plans.
• Delivering consistent clinical decision support across venues.

Guest post by Ron Vatalaro who works at Bisk Education with the University of South Florida Morsani College of Medicine He writes about health informatics.

True cost savings are achieved through implementing proactive preventative care programs across the continuum. Patient electronic health records (EHRs) support that goal, using a common patient database that gives each user access to all relevant patient information. In addition, HIT tools enable access to online guidelines and protocols, consistent clinical decision support (CDS) rules and alerts, care plans and provider communication tools.

The Role of ACOs in a Sustainable Healthcare Future

While ACOs are growing in reach, they also present challenges, particularly because the incentives they offer reduce the fee-for-service avenues that hospitals and physicians currently utilize. A number of factors will determine the long-term sustainability of ACOs, including overall performance in quality care and patient preference. Large employers and individuals may favor ACO-based plans, due to their lower price. ACOs showed early signs of success, so it’s likely that participants will continue to find ways to make a difference to patients while gaining more cost savings.