Accountable Care Trends, Strategies and Best Practice Compliance

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At the heart of care coordination technology is an integrated electronic health record (EHR) providing clinical, financial and administrative functions. The EHR must be able to exchange data among care providers, payors and patients, and be capable of interoperability with private and/or public health information exchange (HIE) infrastructures. The EHR, while storing digital patient data and care plans, must also be able to adhere to quality reporting criteria such as those within the CMS Physician Quality Reporting System (PQRS) and the EHR meaningful use initiative.

Core functionalities such as evidence-based clinical alerts and clinical decision support within the EHR must be aligned with patient data elements such as allergies, lab results, imaging tests such as MRI and ultrasound, therapies and medication history, and even family history to complete the care plan picture.

Integrated analytics solutions are equally important to understand predictive care and subsequent cost modeling in conjunction with risk assessments of medication or surgical care, further enhanced by access to comparative research. Integrated revenue cycle management elements include the ability to compile and submit claims along multiple payment structures, complete with the real-time coding efficiencies.

Patient-centric technologies that focus on beneficiary care plan adherence and understanding range from online personal health records accessible to patients and providers, telehealth capabilities and the emergence of remote monitoring, all again integrated into the longitudinal EHR.

Even the CMS realizes the importance of EHR technology and how they can promote health IT adoption through its accountable care models. The Final Rule speaks to the key component of EHRs as the data-sharing connectivity and clinical support core of necessary health information technology. CMS recognized that the requirement for 50 percent of ACO participants to be meaningful-use users by year two was a tall order, especially as EHR adoption rates are still maturing nationally. To address this, the Final Rule placed EHR adoption as its highest-scoring quality measure, consistently rewarding increased adoption with higher sharing rates, demonstrating the importance of EHR adoption in ACOs.

The importance of accessible, sharable and pertinent data cannot be overstated. Kaiser Permanente, for example, houses a national Total Joint Replacement Registry of more than 100,000 cases offered for clinician review via standardized formats within an EHR infrastructure. Such data must continue to be unearthed and put into the public realm in conjunction with the Medicare Parts A, B, D and claims data that CMS is to provide for care plan benchmarking.


For Rebecca Little, clinical operations director at Genesis OB/GYN, Tucson, Ariz., using technology to manage patient enrollment and identification is a key component of her practice’s membership collaboration with the Tucson Medical Center ACO.

Through the EHR network of Genesis’ 40 providers in 11 locations. “We can get data out to the ACO’s HIE in a mappable fashion and generate summaries and fact sheet documents. Providing data to not only manage patients – but identify who they are – is a huge component of coordinating care," Little states. “We are  developing a flagging functionality with our EHR provider to bridge those patients in the ACO but not yet in the HIE data share, for example. A lot of women who see us don’t go to their primary care doctors, and to manage the provisions for patients who can opt-in or opt-out of a given ACO means fashioning technology for that tracking, and how you get that information to an ER when patients come in."

The Tucson Medical Center ACO is one of the more high-profile models that has so far emerged, in part due to its design and managerial structure by the Brookings Institution and the Dartmouth Institute for Health Policy and Clinical Practice. The model is to be funded by both UnitedHealthcare and CMS. Within this model, providers are to receive a monthly fee covering the costs of coordinated care, with the addition of a performance bonus based on quality components.

“I believe you must have private and public payors involved for an ACO to work, and we know that self-funded employers are also talking to the management structure about joining as well," Little shares. She is confident the model will prove successful, but to be so, she circles her emphasis back to the patient. “We talk about patient retention every day in terms of identifying them within the system, keeping them in the system, and keeping them compliant with care plans. How do you bring them in and then prevent them from leaking out into the community?"

To that end, Little is focused on the concept of incentivizing the patient, whether that’s through the ACO strategies already underway at Genesis, or via new ideas for the ACO going forward. “We have a huge emphasis in our model of nurse case managers being in the field, and for the ACO, we are upstaffing on that side. Genesis already provides incentives to some of our patients through gift cards they receive for ongoing compliance," she says. “In the ACO, we also believe patient incentives through co-pay options could work, and we plan to propose that idea when we go to the payors."


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