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Considering the Health IT Infrastructure for ACOs

June 3, 2011

By Bob Mitchell

As the healthcare industry designs and builds a health IT backbone for Accountable Care Organizations (ACOs), how hospitals view meaningful use and health information exchanges (HIEs) to guide their activity depends on the individual organization, recent research by PricewaterhouseCoopers (PwC) Health Research Institute found.

The American College of Healthcare Executives’ Healthcare Leadership Network of the Delaware Valley (HLNDV) recently invited PwC Director Donna Schmidt to examine the work that’s needed to prepare for ACOs during a recent Webinar for HLNDV members.

Success of an ACO
Schmidt said ACO’s success hinges on, at least in part, the ability to share patient data at the point of care, and relies on historical/longitudinal data for managing population health. As a result, providers must prepare to explore their options in designing a health IT backbone for creating an ACO.

In a recent PwC survey of 300 healthcare executives and administrators, respondents said they want to create an ACO for the following reasons:

1. To deliver and manage care for a defined population
2. To accept payments
3. To distribute any realized savings to participants
4. Perform disease management and predictive modeling to improve outcomes

Creating an ACO
PwC said that when providers create an ACO, they must consider the following things:

The infrastructure
•A provider organization with health IT, physician practice and data analytics capabilities.
Pre-ACO
•An integrated delivery network that already has an existing infrastructure in place that can manage patient populations and manage risk.
Commercial
•A commercial payer contract with different levels of risk sharing and quality measurement requirements.
CMS Shared Savings
•A provider organization accountable for the quality and cost of care for a group of Medicare beneficiaries.

Schmidt said that a provider’s participation in an HIE may occur before the organization participates in an ACO. PwC’s research shows that most ACO discussions remain internally focused, despite their being concerns about how to access external data, often with competitors.

She said that participants in a few of the existing ACOs across the country are relying on private HIEs to address their data-sharing needs. And, while meaningful use and ACO requirements overlap, there is still not a concerted effort by providers to align their efforts with another provider.

The unknowns
With the rise in HIE and ACO activity, there are still many unknowns. When respondents to a PwC Health Research Institute survey were asked about IT implications of healthcare reform, 47 percent said they did not know their involvement in ACOs. “They’re still trying to understand how they would do this, and there is much less work being done outside the organization on ACOs,” Schmidt said. “ACOs are heavily dependent on private HIEs for data sharing, and with meaningful use and ACO requirements overlapping, more work needs to be done to align providers. These are not disparate initiatives; most organizations will see value in the ‘ahead-of-time’ planning activities they perform.”

Schmidt said that having an IT backbone and building ACOs on data requirements will be most effective at the local and regional HIE level. “There will be strategic advantages, and it helps organizations build their network with providers and other facilities they are affiliated with.”

Steps to an ACO strategy
The first step in developing an ACO strategy is to initially plan the organization’s meaningful use compliance and evolution. The second step is to look at the data and analytic requirements, Schmidt said. “What data is going to be necessary to share for care transitions, or historical and longitudinal data?” she asked.

When looking at data capture and sharing capabilities, it’s important to remember that some departmental systems may not be fully integrated. “Where’s the data? What is the business intelligence/ analysis that’s required? How do we make use of the data? How do we inform patients on how the data is being used?” Schmidt asked. “These are all important considerations.

“No single model is right or wrong,” Schmidt said. “You must apply elements as to what’s appropriate or not. What are the exchange capabilities that currently exist? What is being built in the region or at the state level? What’s your organization’s capital position? What’s the cost of setting up an ACO? As we have seen, physician relationships are critical in how provider organization work with physicians: these relationships are important.”

Mitchell is a freelance writer and blogger based in suburban Philadelphia.

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