Accountable Care Organizations:Overview and the Role of Information Technology<br />Colin Konschak, MBA, FHIMSS<br />Mary ...
Objectives<br />Describe the intention and programmatic features of the Medicare Shared Savings Program<br />Identify fina...
Level Setting<br />Commercial Accountable Care Organizations (ACOs)<br />Medicare Shared Savings Program ACOs<br />Notice ...
Affordable Care Act<br />Patient Protection and Affordable Care Act / Health Care and Education Reconciliation Act of 2010...
Value Based Purchasing<br />Links payments directly to the quality of care delivered<br />Rewards providers for high quali...
Shared Savings Program<br />Intentions<br />Promote accountability for a population<br />Improve coordination of items and...
Two Distinct Models<br />Shared savings model<br />Entry point for less experienced organizations in accepting financial r...
© 2010 DIVURGENT. All rights reserved.<br />8<br />ACO Roadmap:  Navigating the Financial Issues for Your ACO<br />Source:...
© 2010 DIVURGENT. All rights reserved.<br />9<br />
Organizational Models<br />© 2010 DIVURGENT. All rights reserved.<br />10<br />
ACO<br />1<br />2<br />ACO<br />IPA or Primary Care Group<br />MSPG<br />Specialty <br />Groups<br />HOSPITAL<br />HOSPITA...
© 2010 DIVURGENT. All rights reserved.<br />12<br />Principles of Successful Integration<br />
“Relational Model of How High-Performance Work Systems Work”<br />High Performance Work Practices<br />Selection for Cross...
ACO Change Management Model<br />14<br />© 2010 DIVURGENT. All rights reserved.<br />
© 2010 DIVURGENT. All rights reserved.<br />15<br />ACO Roadmap: Governance and Launch<br />
Quality Measurement<br />© 2010 DIVURGENT. All rights reserved.<br />16<br />
Measurement Areas for ACOs<br />Outcomes<br />Process<br />Patient Experience<br />Utilization<br />Care<br />Coordination...
Leverages Current Quality Measures<br />18<br />© 2010 DIVURGENT. All rights reserved.<br />
Reflects Chronic Care Model<br />Wagner EH. Chronic disease management: what will it take to improve care for chronic illn...
Quality Reporting Measures<br />Better Care for Individuals <br />Better Health for Populations<br />42 CFR Part 425 [CMS-...
Patient/Caregiver Experience<br />Timely care, appointments and information<br />How well doctors communicate<br />Helpful...
All based on NQF standards</li></ul>21<br />© 2010 DIVURGENT. All rights reserved.<br />
Care Coordination<br />30-day acute care readmission rates<br />30-day post discharge physician visit<br />Medication reco...
Measures based on CMS, NQF and HITECH</li></ul>22<br />© 2010 DIVURGENT. All rights reserved.<br />
Patient Safety<br />Health Care Acquired Conditions:<br />Foreign object retained after surgery<br />Air embolism<br />Blo...
Measures based on CMS and NQF standards</li></ul>23<br />© 2010 DIVURGENT. All rights reserved.<br />
Preventive Health<br />Influenza immunization<br />Pneumococcal vaccination<br />Mammography screening within 24 months<br...
At-Risk Populations<br />Diabetes – 10 measures<br />Heart Failure – 7 measures<br />Coronary Artery Disease – 6 measures<...
Measures based on CMS, PQRS, HITECH and NQF measures</li></ul>25<br />© 2010 DIVURGENT. All rights reserved.<br />
Technologies Involved in Quality Management<br />26<br />© 2010 DIVURGENT. All rights reserved.<br />
© 2010 DIVURGENT. All rights reserved.<br />27<br />Results of Physician Group Practice Demonstration (Through 12/2010)<br />
ACO Roadmap: Quality<br />28<br />© 2010 DIVURGENT. All rights reserved.<br />
Information Technology Implications<br />© 2010 DIVURGENT. All rights reserved.<br />29<br />
May “require the use of specific decision support tools...”<br />In the application, an ACO must provide documentation des...
© 2010 DIVURGENT. All rights reserved.<br />31<br />ACO IT Reference Model<br />Key Themes:<br /><ul><li>While much of the...
Much of  the technology called for is not readily available in the marketplace
Expect many HIT products used by payers to be modified for use by providers
As the incentives build to keep patients healthy and out of provider facilities, home health & telehealth technology innov...
Privacy and security infrastructure will take on heightened importance and complexity
Key ACO IT building blocks – such as HIEs – will quickly expand into new functionality areas
While CMS may be calling for end-to-end HIT capabilities at ACO start-up, many private ACO’s can start with HIT “baby-step...
© 2010 DIVURGENT. All rights reserved.<br />33<br />ACO Alignment w. MU<br />Legend:  Alignment to Meaningful Use<br />Pat...
ACO IT Reference Model<br />Patient<br /><ul><li>HIE’s are the key IT enabler for care coordination, giving all providers ...
Besides clinical data sharing, HIEs support handoff’s such as referrals and care transitions
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  • NPRM released March 31, 2011Accountable Care Organization (ACO) means a legal entity that is recognized and authorized under applicable State law, as identified by a TIN, and comprised of an eligible group of ACO participants that work together to manage and coordinate care for Medicare FFS beneficiaries and have established a mechanism for shared governance that provides all ACO participants with an appropriate proportionate control over the ACO’s decision making processACO participant means a Medicare-enrolled provider of services and/or a supplierACO provider/supplier means a provider of services and/or a supplier that bills for items and services it furnishes to Medicare beneficiaries under a Medicare billing number assigned to the TIN of an ACO participant in accordance with applicable Medicare rules and regulations
  • In March of ‘10 PPACA was enacted, The HCERA was then enacted which amended it. Together, they are known as the Affordable Care ActDefinition of the Shared Savings Program, “a program that promotes accountability for a patient population and coordinates items and services under Parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery”
  • Links payments directly to the quality of care deliveredRewards providers for high quality, efficient careImprove QualityUse of adjusted outcome and patient experience measuresMeasures aligned cross Medicare and MedicaidAligned with MU measures and best practicesLower growth in expendituresReward providers for reducing unnecessary expendituresContinual improvement of qualityUse of ongoing cost reducing and quality improving redesigned care processes across the entire patient population
  • Reduce growth in expendituresEstimated net savings for CY’s 2012 through 2014 = $510MEstimate 75-150 ACOs in first 3 years of the program
  • Shared savings model (one-sided model)Entry point for less experienced organizations in accepting financial riskAllows for time to gain experience, while under the FFS modelProposed that these organizations will transition to the two-sided model in their final year of their initial agreementShared savings/losses model (two-sided model)For those organizations experienced with managing population health and accepting riskGreater reward for those accepting riskOnly for MSS, Commercial ACOs come in a variety of flavors
  • Previous slide we talked about expectations, the NPRM gives us clearer direction on the requirements:
  • Technology such as CDS or a paper based methodology would likely sufficeTechnology such as portals, PHR’s, or paper based education as well as just engaging them in the processSuch reporting may include “developing a population health data management capability” or “implementing practice and physician level data capabilities with Point of service reminder systems” Measuring physician clinical and service performance, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.” They are looking for ACOs to coordinate care across the ENTIRE continuum. They give examples such as:Capability to use predictive modeling to anticipate likely care needsUtilization of case managers in primary care officesRemote monitoringTelehealthEstablishment and use of HIT, including EHR and HIE to enable the provision of a beneficiary’s summary of care record during transitions of care both within and outside of the ACO.
  • Transaction based vs. Value basedCommercial vs. CMS ACOShared SavingsTriple AimStructure and GovernanceLegal ConsiderationsFundamentally different than the HMOFee for Service paymentsLegislative Next StepsOngoing alignment between ACO and MUInvestments in HIT are expected and required
  • Traditionally non radiologists referred patients needing MRI to hospitals and other facilitiesThose factilities billed for the services, the referring physician did not bill anythingOver 1.5M episodes of care with 11,844 total orthodpedists and 6k neurologists- The 6% increase in spending was not only accounted for by MRI. Other services and procedures also accounted for the increase.Why? Financial? Convenience? Quality?Convenience: easier to make a referral, less paperwork, patient doesn’t have to go somewhere else. **However, much of the MRI useage did not occur on the day of the first visit but on a subsequent visit.
  • As prez4web061611

    1. 1. Accountable Care Organizations:Overview and the Role of Information Technology<br />Colin Konschak, MBA, FHIMSS<br />Mary Sirois, MBA, CPHIMS<br />David Shiple<br />© 2010 DIVURGENT. All rights reserved.<br />1<br />
    2. 2. Objectives<br />Describe the intention and programmatic features of the Medicare Shared Savings Program<br />Identify financial impacts associated with the accountable care organization<br />Describe potential delivery models for the accountable care organization<br />Describe quality reporting requirements and issues<br />Identify HIT requirements for the Medicare Shared Savings Program<br />Identify alignment between Meaningful Use requirements and Shared Savings requirements<br />Describe a potential ACO IT reference model<br />© 2010 DIVURGENT. All rights reserved.<br />2<br />
    3. 3. Level Setting<br />Commercial Accountable Care Organizations (ACOs)<br />Medicare Shared Savings Program ACOs<br />Notice of Proposed Rulemaking (NPRM) <br />Definition of an Accountable Care Organization<br />Legal entity<br />Comprised of an eligible group of ACO participants <br />Established a mechanism for shared governance<br />© 2010 DIVURGENT. All rights reserved.<br />3<br />
    4. 4. Affordable Care Act<br />Patient Protection and Affordable Care Act / Health Care and Education Reconciliation Act of 2010<br />Goals:<br />Improve quality of Medicare services<br />Support innovation<br />Establish new payment models<br />Align payments with costs<br />Strengthen program integrity<br />Secure financial future of the program<br />Requires the Secretary to establish the Medicare Shared Savings Program with a three part aim:<br />Better care for individuals<br />Better health for populations<br />Lower growth in expenditures<br />© 2010 DIVURGENT. All rights reserved.<br />4<br />
    5. 5. Value Based Purchasing<br />Links payments directly to the quality of care delivered<br />Rewards providers for high quality, efficient care<br />Improve Quality<br />Lower growth in expenditures<br />© 2010 DIVURGENT. All rights reserved.<br />5<br />
    6. 6. Shared Savings Program<br />Intentions<br />Promote accountability for a population<br />Improve coordination of items and services<br />Encourage investment in infrastructure<br />Redesign care processes to improved quality and efficiency<br />Share savings with the ACO<br />Achieve at the highest level, the three-part aim<br />Reduce growth in expenditures<br />The Program Itself<br />Allows for providers to work together<br />Establishes shared savings payments<br />Secretary given discretion to determine assignment of beneficiaries <br />Establishes principles and requirements for payments and treatment of savings<br />Payments will continue under FFS<br />Establishes the methodology to calculate savings<br />ACOs must not avoid at-risk patients<br />© 2010 DIVURGENT. All rights reserved.<br />6<br />
    7. 7. Two Distinct Models<br />Shared savings model<br />Entry point for less experienced organizations in accepting financial risk<br />Allows for time to gain experience, while under the FFS model<br />Proposed that these organizations will transition to the two-sided model in their final year of their initial agreement<br />Shared savings / losses model<br />For those organizations experienced with managing population health and accepting risk<br />Greater reward for those accepting risk<br />© 2010 DIVURGENT. All rights reserved.<br />7<br />
    8. 8. © 2010 DIVURGENT. All rights reserved.<br />8<br />ACO Roadmap: Navigating the Financial Issues for Your ACO<br />Source: Accountable Care Organizations: A Roadmap for Success by Bruce Flareau, MD<br />
    9. 9. © 2010 DIVURGENT. All rights reserved.<br />9<br />
    10. 10. Organizational Models<br />© 2010 DIVURGENT. All rights reserved.<br />10<br />
    11. 11. ACO<br />1<br />2<br />ACO<br />IPA or Primary Care Group<br />MSPG<br />Specialty <br />Groups<br />HOSPITAL<br />HOSPITAL<br />ACO<br />ACO<br />ACO<br />4<br />3<br />5<br />Private Payer<br />Physician-Hospital Organization<br />IDN<br />Hospital<br />Affiliate Physicians<br />Employed<br />Physician<br />CIN<br />CIN<br />Delivery Models for ACOs<br />11<br />© 2010 DIVURGENT. All rights reserved.<br />
    12. 12. © 2010 DIVURGENT. All rights reserved.<br />12<br />Principles of Successful Integration<br />
    13. 13. “Relational Model of How High-Performance Work Systems Work”<br />High Performance Work Practices<br />Selection for Cross-functional Teamwork<br />Cross-functional Conflict Resolution<br />Cross-functional Performance Measurement<br />Cross-functional Rewards<br />Cross-functional Meetings<br />Cross-functional Boundary Spanners<br />Quality Outcomes<br />Patient-Perceived<br />Quality of Care<br />Relational Coordination<br />Shared Goals<br />Shared Knowledge<br />Mutual Respect<br />Frequent Comm.<br />Timely Comm.<br />Accurate Comm.<br />Problem Solving Comm.<br />Efficiency Outcomes<br />Patient Length of Stay<br />Note: Model from the work of Dr. Jody Gittell on Relational Coordination in Healthcare Organizations. http://www.jodyhoffergittell.info/content/rc2c.html <br />13<br />© 2010 DIVURGENT. All rights reserved.<br />
    14. 14. ACO Change Management Model<br />14<br />© 2010 DIVURGENT. All rights reserved.<br />
    15. 15. © 2010 DIVURGENT. All rights reserved.<br />15<br />ACO Roadmap: Governance and Launch<br />
    16. 16. Quality Measurement<br />© 2010 DIVURGENT. All rights reserved.<br />16<br />
    17. 17. Measurement Areas for ACOs<br />Outcomes<br />Process<br />Patient Experience<br />Utilization<br />Care<br />Coordination<br />Access<br />To Care<br />17<br />© 2010 DIVURGENT. All rights reserved.<br />
    18. 18. Leverages Current Quality Measures<br />18<br />© 2010 DIVURGENT. All rights reserved.<br />
    19. 19. Reflects Chronic Care Model<br />Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2-4.  (The Chronic Care Model image first appeared in its current format in this article)<br />Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20:64-78.<br />Copyright 1996-2011 The MacColl Institute.  The Improving Chronic Illness Care program is supported by The Robert Wood Johnson Foundation, with direction and technical assistance provided by Group Health's MacColl Institute for Healthcare Innovation<br />19<br />© 2010 DIVURGENT. All rights reserved.<br />
    20. 20. Quality Reporting Measures<br />Better Care for Individuals <br />Better Health for Populations<br />42 CFR Part 425 [CMS-1345-P]<br />RIN 0938-AQ22 Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations<br />20<br />© 2010 DIVURGENT. All rights reserved.<br />
    21. 21. Patient/Caregiver Experience<br />Timely care, appointments and information<br />How well doctors communicate<br />Helpful, courteous, respectful office staff<br />Patient’s rating of doctor<br />Shared decision making<br />Health status/functional status<br /><ul><li>All measures collected via patient survey
    22. 22. All based on NQF standards</li></ul>21<br />© 2010 DIVURGENT. All rights reserved.<br />
    23. 23. Care Coordination<br />30-day acute care readmission rates<br />30-day post discharge physician visit<br />Medication reconciliation 60 days following hospital discharge<br />Quality of preparation for care transition<br />Ambulatory Sensitive Conditions<br />Diabetes short-term complications<br />Uncontrolled diabetes<br />COPD<br />CHF<br />Dehydration<br />Bacterial pneumonia<br />Urinary tract infection<br />Stage 1 Meaningful Use<br />% ALL physicians<br />% PCP<br />% PCPs using clinical decision support<br />% PCPs using eRx<br />Patient registry use<br /><ul><li>Data submission via claims, GPRO, patient survey
    24. 24. Measures based on CMS, NQF and HITECH</li></ul>22<br />© 2010 DIVURGENT. All rights reserved.<br />
    25. 25. Patient Safety<br />Health Care Acquired Conditions:<br />Foreign object retained after surgery<br />Air embolism<br />Blood incompatibility<br />Stage II and IV pressure ulcers<br />Falls and trauma<br />Catheter-associated UTI<br />Manifestations of poor glycemic control<br />Central line associated blood stream infection<br />Surgical site infection<br />AHRQ Patient Safety indicators<br />Accidental puncture or laceration<br />Iatrogenic pneumothorax<br />Post op DVT or PE<br />Post op wound dihiscence<br />Decubitus ulcer<br />Selected infections due to medical care<br />Post op hip fracture<br />Post op sepsis<br />CLABSI bundle<br /><ul><li>Data submission via claims or CDC National Healthcare Safety Network
    26. 26. Measures based on CMS and NQF standards</li></ul>23<br />© 2010 DIVURGENT. All rights reserved.<br />
    27. 27. Preventive Health<br />Influenza immunization<br />Pneumococcal vaccination<br />Mammography screening within 24 months<br />Colorectal screening<br />Cholesterol management for patients with cardiovascular conditions<br />Adult weight screening and follow-up<br />Blood pressure measurement in patient with hypertension<br />Tobacco use assessment and tobacco cessation intervention<br />Depression screening<br /><ul><li>Data submission via GPRO data collection tool Measures based on PQRS, HITECH and NQF measures</li></ul>24<br />© 2010 DIVURGENT. All rights reserved.<br />
    28. 28. At-Risk Populations<br />Diabetes – 10 measures<br />Heart Failure – 7 measures<br />Coronary Artery Disease – 6 measures<br />Hypertension – 2 measures<br />COPD – 3 measures<br />Frail Elderly – 3 measures<br /><ul><li>Data submission via GPRO data collection tool and claims(1)
    29. 29. Measures based on CMS, PQRS, HITECH and NQF measures</li></ul>25<br />© 2010 DIVURGENT. All rights reserved.<br />
    30. 30. Technologies Involved in Quality Management<br />26<br />© 2010 DIVURGENT. All rights reserved.<br />
    31. 31. © 2010 DIVURGENT. All rights reserved.<br />27<br />Results of Physician Group Practice Demonstration (Through 12/2010)<br />
    32. 32. ACO Roadmap: Quality<br />28<br />© 2010 DIVURGENT. All rights reserved.<br />
    33. 33. Information Technology Implications<br />© 2010 DIVURGENT. All rights reserved.<br />29<br />
    34. 34. May “require the use of specific decision support tools...”<br />In the application, an ACO must provide documentation describing plans to:<br />Promote evidence based medicine<br />Promote beneficiary engagement<br />Report internally on quality and cost metrics<br />Coordinate care<br />Beneficiaries should have access to their own medical records<br />Act mentions processes for the electronic exchange of information<br />Process for evaluating health needs of the population<br />“Should have a process in place (or clear path) to electronically exchange summary of care information when patients transition to another provider or setting of care, both within and outside the ACO, consistent with MU requirements.”<br />Individualized care plans shared throughout the continuum<br />© 2010 DIVURGENT. All rights reserved.<br />30<br />Medicare ACO IT Requirements<br />Requires an ACO to “define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.”<br />
    35. 35. © 2010 DIVURGENT. All rights reserved.<br />31<br />ACO IT Reference Model<br />Key Themes:<br /><ul><li>While much of the required IT investment for ACOs overlaps with Meaningful Use, most of it does not, and will require a new IT strategic planning approach
    36. 36. Much of the technology called for is not readily available in the marketplace
    37. 37. Expect many HIT products used by payers to be modified for use by providers
    38. 38. As the incentives build to keep patients healthy and out of provider facilities, home health & telehealth technology innovation will accelerate
    39. 39. Privacy and security infrastructure will take on heightened importance and complexity
    40. 40. Key ACO IT building blocks – such as HIEs – will quickly expand into new functionality areas
    41. 41. While CMS may be calling for end-to-end HIT capabilities at ACO start-up, many private ACO’s can start with HIT “baby-steps” </li></li></ul><li>ACO IT Reference Model<br />Legend: What is/ will be on the radar screen for:<br />Patient<br />Payers<br />ACO's<br />Providers<br />Survey Tools<br />PHR<br />Self-Service<br />Secure Communications<br />Coordinated Care Plans<br />Health Plan<br />Hospital<br />Specialist<br />Primary Care<br />Community Support Providers<br />Claims<br />EHR<br />EHR<br />EHR<br />EHR<br />Member Registry<br />EMPI<br />Security Infrastructure<br />Health Information Exchange<br />Disease Mgt<br />Enterprise Data Warehouse<br />Care Mgt<br />Disease Registries<br />Enrollment<br />Data Analytics<br />32<br />© 2010 DIVURGENT. All rights reserved.<br />Risk Mgt<br />ACO Revenue Cycle Management<br />
    42. 42. © 2010 DIVURGENT. All rights reserved.<br />33<br />ACO Alignment w. MU<br />Legend: Alignment to Meaningful Use<br />Patient<br />Not Applicable<br />Stage 2<br />Stage 1<br />Survey Tools<br />PHR<br />Self-Service<br />Secure Communications<br />Coordinated Care Plans<br />Health Plan<br />Hospital<br />Specialist<br />Primary Care<br />Community Support Providers<br />Claims<br />EHR<br />EHR<br />EHR<br />EHR<br />Member Registry<br />EMPI<br />Security Infrastructure<br />Health Information Exchange<br />Disease Mgt<br />Enterprise Data Warehouse<br />Care Mgt<br />Disease Registries<br />Enrollment<br />Data Analytics<br />© 2010 DIVURGENT. All rights reserved.<br />Risk Mgt<br />ACO Revenue Cycle Management<br />
    43. 43. ACO IT Reference Model<br />Patient<br /><ul><li>HIE’s are the key IT enabler for care coordination, giving all providers a view of a patient’s longitudinal record
    44. 44. Besides clinical data sharing, HIEs support handoff’s such as referrals and care transitions
    45. 45. Most HIEs contain a data repository, which can be used to feed a data warehouse
    46. 46. HIE challenges include governance, privacy/ security concerns, and financial sustainability</li></ul>Survey Tools<br />PHR<br />Self-Service<br />Secure Communications<br />Coordinated Care Plans<br />Health Plan<br />Hospital<br />Specialist<br />Primary Care<br />Community Support Providers<br />Claims<br />EHR<br />EHR<br />EHR<br />EHR<br />Member Registry<br />EMPI<br />Security Infrastructure<br />Health Information Exchange<br />Disease Mgt<br />Enterprise Data Warehouse<br />Care Mgt<br />Disease Registries<br />Enrollment<br />Data Analytics<br />© 2010 DIVURGENT. All rights reserved.<br />Risk Mgt<br />ACO Revenue Cycle Management<br />
    47. 47. 35<br />ACO IT Reference Model<br /><ul><li>Longitudinal data warehouses are not readily available in the marketplace, but are needed to support quality reporting, care management, care coordination, and other ACO requirements
    48. 48. Most enterprise vendors have not excelled at longitudinal data aggregation, so other strategies are being adopted
    49. 49. Buying the start of a data warehouse with products such as Amalga, Recombinant, and Healthcare Data Works
    50. 50. Buying the data model from vendors such as IBM, Oracle, or Teradata as starting point
    51. 51. Building the data warehouse “ground up” as a custom development effort
    52. 52. Relying on analytics specialists to combine and analyze data from various applications (with tools such as SAS) to meet the ACO business needs
    53. 53. Robust, longitudinal data repositories could have profound effects – for the first time, health systems will have more longitudinal data than payers, giving providers more negotiating leverage</li></ul>Patient<br />Survey Tools<br />PHR<br />Self-Service<br />Secure Communications<br />Coordinated Care Plans<br />Health Plan<br />Hospital<br />Specialist<br />Primary Care<br />Community Support Providers<br />Claims<br />EHR<br />EHR<br />EHR<br />EHR<br />Member Registry<br />EMPI<br />Security Infrastructure<br />Health Information Exchange<br />Disease Mgt<br />Enterprise Data Warehouse<br />Care Mgt<br />Disease Registries<br />Enrollment<br />Data Analytics<br />© 2010 DIVURGENT. All rights reserved.<br />Risk Mgt<br />ACO Revenue Cycle Management<br />
    54. 54. In Summary<br />Transaction based vs. Value based<br />Commercial vs. CMS ACO<br />Triple Aim<br />Legislative Next Steps<br />Ongoing alignment between ACO and MU<br />Expect experimentation, innovation and disruption<br />© 2010 DIVURGENT. All rights reserved.<br />36<br />
    55. 55. Discussion<br />© 2010 DIVURGENT. All rights reserved.<br />37<br />
    56. 56. © 2010 DIVURGENT. All rights reserved.<br />38<br />ACO IT Observations<br /><ul><li>As the incentive shifts from volume to controlling costs, many technologies with slow adoption could now accelerate in adoption:
    57. 57. Personal Health Records
    58. 58. Remote Monitoring
    59. 59. Telehealth
    60. 60. Early Detection Devices
    61. 61. Fitness Trackers
    62. 62. Many others
    63. 63. HIEs are likely to see a surge in interest (even beyond MU drivers), and expand into many functionality areas:
    64. 64. PHRs
    65. 65. Analytics
    66. 66. Care Coordination Workflow</li></li></ul><li>© 2010 DIVURGENT. All rights reserved.<br />39<br />ACO IT Observations<br /><ul><li>Robust, longitudinal data warehouses will be needed, but are not readily available in the market
    67. 67. Many ACO’s will build custom data warehouses
    68. 68. While complete data warehouses are emerging in the market, data models are available today
    69. 69. Experienced data analysts will be essential: normalizing, abstracting, and interpreting data will increasingly be highly valued skill set
    70. 70. Expect many ACO’s to use a combination of manual processes and BI/ Analytics tools to combine data sources and perform analysis needed</li></li></ul><li>© 2010 DIVURGENT. All rights reserved.<br />40<br />ACO IT Observations<br /><ul><li>Many required IT solutions do not exist today, or will have to be repurposed,e.g.:
    71. 71. Financial systems that have capability to report on ACO participant performance and manage savings/ loss distributions
    72. 72. Care management (CM) and disease management (DM) systems currently used by payers (with claim data), may be repurposed for provider use
    73. 73. A new clinical specialty is likely do to arise – the Care Coordinator - with authority and expertise make referral and care decisions
    74. 74. Provider-based CM and DM systems using EHR data will be essential for this function</li></li></ul><li>© 2010 DIVURGENT. All rights reserved.<br />41<br />ACO Roadmap: Establishing the ACO Technology Framework <br />
    75. 75. Conduct readiness assessment<br />Governance<br />IT Infrastructure<br />Physician Alignment<br />Risk Tolerance / Management<br />Ability to manage population health<br />Engage health plans and major employers in risk sharing discussions<br />Engage physician community<br />Accelerate cost reduction and clinical integration initiatives<br />Develop value-based purchasing IT strategy<br />Conduct financial impact analysis<br />Explore innovative delivery models<br />© 2010 DIVURGENT. All rights reserved.<br />42<br />Recommended Next Steps<br />
    76. 76. Transaction / Value Based<br />What happens when Physicians acquire MRI equipment in-office?<br />Study examined changes in imaging use and in overall spending<br />Methodology<br />Examined Medicare claims data<br />Orthopedic surgeons and neurologists<br />Results<br />Ability to bill for MRI led to substantial increases in MRI utilization<br />Also, total Medicare spending for these patients increased by as much as 6% after 90 days from initial visit<br />Why might this be?<br />Source: Health Affairs, December 2010 29:12, pgs2252-2259<br />© 2010 DIVURGENT. All rights reserved.<br />43<br />
    77. 77. Contact us for more information atinfo@DIVURGENT.com<br />www.DIVURGENT.com<br />© 2010 DIVURGENT. All rights reserved.<br />44<br />Contact Us<br />

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