Accountable Care Organizations: Savings, Quality, and Information Technology

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Key drivers of shared savings and the role of health information technology.

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Accountable Care Organizations: Savings, Quality, and Information Technology

  1. 1. Accountable Care Organizations:Savings, Quality, & Health Information TechnologyRobert Bond, MBA | robert@acoadvantage.com | 484.431.3015 (mobile)ACOAdvantage (www.acoadvantage.com)ACOAdvantage Breakthrough Performance in the Health Reform Erawww.acoadvantage.com
  2. 2. Framework to Guide ACO Shared Savings Levers Influencing Cost & Quality of Care Levers affecting DEMAND 1 Promote health and wellness amongst individuals and populations Actively manage demand for health care products and services Ensure value-conscious consumption 2 among providers and patients What levers must an ACO Levers affecting RISK follow topromote quality, Actively identify high-risk patients and 3 cost develop individualized care plans effectiveness, Levers affecting COST and service Promote efficient creation of capacity for 4 sustainability Develop resources and labor, infrastructure, and innovation infrastructure to foster Design and develop new models for cost reducing innovations 5 care delivery which promote in care processes efficiency and quality Levers affecting QUALITY Promote improvements to care 6 coordination amongst providers Promote and implement activities focused on Promote evidence-based medicine & improving care process 7 clinical knowledge outcomesACOAdvantage© Collect, analyze, and disseminate 8 performance and outcome metrics
  3. 3. Accountable Care Organizations Model Principles Key Principles for Formation of an ACO Performance Local Accountability Shared Savings MeasurementACOs will consist of locally based Reimbursement model for ACOs is “You can’t manage what you don’tproviders. Benchmarks for ACO termed “Shared Savings.” Shared measure. “ ACOs will provide metrics onspending are based on historical savings combine fee-for–service with clinical process, outcome measures, andspending patterns and risk-adjusted cost savings. the patient experience.based on patient mix. The local ACOis accountable for costs, quality, andcapacity. ACOAdvantage©Source: "The Promise ACOs." Accountable Care Organization Learning Network. The Engelberg Center for Health Care Reform at Brookings and the Dartmouth Institute for HealthPolicy & Clinical Practice , n.d. Web. 18 Apr 2011. <http://www.acolearningnetwork.org/who-we-are/about-the-network>. 2
  4. 4. Accountable Care Organizations Model Principles Key Principles for Formation of an ACO1 Continuity of Care Continutity of care provides for the end to end care of patients. Information and instructions are passed from provider to provider. 2 Alignment of Incentives Shared savings create an Key alignment of financial care and Components outcomes. Traditional models of of care (e.g., fee-for-service) can Accountable result in a financial discentive for Care care improvement 3 Infrastructure Infrastructure Information technology system through ACOAdvantage© which data is gathered, organized, and shared.
  5. 5. Formation Stages of an Accountable Care Organization Evolution of Provider Focus on Health IT Infrastructure Beginning Intermediate Advanced Health of Population Scope of Provider Focus  Measures are more fully focused on  Limited clinical and outcomes and patient survey data patient is available experience  Providers focus Providers focus increases towards on population the full continuum health and share  Providers use of care accountability process based for care Discrete measures Patient  Focus is on discrete patient encounters ACOAdvantage©Encounters Level of Health IT Infrastructure and Data Availability Paper-Based Records / Sophisticated EHR / PHR & Claims-Based (e.g., Medical, Laboratory, Pharmacy) Rich clinical and patient survey data
  6. 6. ACO Success Enabled by Health IT Key Functions Supported by Information Technology Manage Risk Performance Measurement Providers will need to develop ACOs will need to master performance capability in managing financial risk. measurement to manage risk and Most providers will be able to handle Manage Measure achieve savings. Metrics include performance risk; however, they Financials Performance population health, quality of care, and lack capabilities to manage patient satisfaction. insurance risk.Coordinate Care Coordinate Building the Train Providers & StaffCoordination of care between Trainproviders and settings will be Care Successful Both providers and staff willessential. New or redesigned ACO Providers require training on new & Staff workflows, processes, and teamworkflow processes will reduce work. Changing providerduplicate efforts, pass information behavior is a particularseamlessly, and become patient challenge.centric. Engage Provide Engage Patients Patients Information Engaging patients in caring for their Provide Information health will require providers to develop Accurate, real-time information is or acquire capabilities in disease essential to the success of the ACO. management, personal health records, Especially vital is clinical decision patient portal, and patient education. support at the point of care. Providers Legend ACOAdvantage© will need evidence-based clinical guidelines, alerts, and reminders. = Relies on Health IT
  7. 7. Accountable Care Organizations Nationwide Examples of ACOs Formed or in Formation as of Q2 2011 Steward Healthcare Cape Code Healthcare Boston, MA Hyannis, MA Wyoming Med Center Casper, WY Montifore Med Center Catholic Healthcare West Advocate Healthcare New York, NY Hill Physicians Louisville, KY San Ramon, CA Atlantic Health Morristown, NJ Norton Healthcare Carilion Clinic Healthcare Partner Louisville, KY Roanoke, VA Torrance, CA Banner Health Arizona Tucson Medical CenterMonarch Healthcare Tucson, AZ Irvine, CA ACOAdvantage©
  8. 8. Accountable Care OrganizationsRobert Bond, MBAPartnerACOAdvantage (www.acoadvantage.com)robert@acoadvantage.com | 484.431.3015

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