White Paper - Building Your ACO and Healthcare IT’s Role


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The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.

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White Paper - Building Your ACO and Healthcare IT’s Role

  1. 1. Building Your ACO and Healthcare IT’s Role NextGen Healthcare Collaborative Care Solutions Update a QSI company TM
  2. 2. nextgen.com Healthcare at the Speed of Light Where do you fit in the American healthcare ecosystem? You need to know. Where does your practice stand relative to one of the most complex, interconnected, and constantly evolving business models in the history of healthcare? Being clear on where you are in the stakeholder spectrum, and what you need to do to succeed, is essential to meeting today’s healthcare marketplace demands. The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light.1 The HIT Revolution — It’s Unstoppable People and organizations offering the best HIT insights, knowledge, skills, and technologies to successfully manage the healthcare information revolution, constantly assess how to provide value to the market. They are highly sought-after because they move with the market. They are always relevant and timely. These industry pundits create dialogs and relationships with stakeholders that reflect market realities and stakeholder objectives. These high performers turn roadblocks into opportunities. They will always be in high demand, as will HIT solutions that advance the quality and efficiency of American healthcare. Stephen Lieber, president and CEO, Healthcare Information and Management Systems Society (HIMSS), said last summer at a vendor leadership exchange in Chicago, “The change in healthcare to be more like the rest of American business… is underway and will not be stopped.”2 The country’s health IT leader, Farzad Mostashari, heads the Office of the National Coordinator for Health IT (ONC). At the first 2012 meeting of the Health IT Policy Committee he said, “In 2012, Meaningful Use will soar.” “We’re going to do everything we can to ensure that every provider can be successful at Meaningful Use. Vendors and providers are going to be asked to step up to the challenge – and it is a challenge. But, it’s a challenge well worth meeting.”3 Farzad Mostashari, Office of the National Coordinator
  3. 3. Building Your ACO and Healthcare IT’s Role | Page 3 What We Know Today — How We Prepare for Tomorrow Healthcare stakeholders of every size and description in 2012 are gearing up for a faster pace of HIT adoption, implementation, and increased influence in every part of the clinical, financial, and administrative workflow. We know the hottest buzzwords and we understand their true implications: • Meaningful Use (MU) • Patient Centered Medical Home (PCMH) • Accountable Care Organization (ACO) Today, public and private organizations have a loose understanding about these quality care mega models. In fact, the federal government, many non-governmental organizations (NGOs), and private sector professional societies have created their own distinct definitions. NextGen Healthcare is and has been a leading innovator supporting emerging healthcare reform models and patient engagement as far back as 2003. We understand health reform, the implications and trends, and are developing the best solutions to ensure short- and long- term success for the healthcare community in overcoming challenges faced by physician practices, hospitals, HIEs, the government, Integrated Delivery Networks (IDNs), and other providers across the country. ACO ACO ORGANIZATION Infrastructure and Legal Entity Manage, Monitor and Track Across the ACO Network Governance and Administration PCMH Large Primary Care Practice Large Multi- specialty Integrated Delivery System Practice Provider IPA and/or MSO ACO PARTICIPANT Patient Centered Care Delivery Population Management Patient Satisfaction
  4. 4. nextgen.com MU Momentum Meaningful Use is on the fast track of adoption and acceptance. The federal government has given providers more time to ramp up electronic health record (EHR) implementations – the initial focus of the Centers for Medicare and Medicaid (CMS) EHR Incentive Program. The Comment Period available through the federal government’s regulations.gov website is open for feedback on the MU Stage 2 Proposed Rules until May 7, 2012. Even so, while hospitals maintain their impressive EHR adoption momentum in 2012 and beyond, small physician practices will begin moving beyond “the unstoppable” as earlier adopters receive and publicize their MU incentive checks. Regardless of current national adoption rates, EHRs and MU already are entering a new phase prompted by the legal implications of Health Insurance Portability and Accountability Act (HIPAA.) Security breaches, EHR default templates, and cloned notes (causing improper billing) are forcing CMS to begin auditing recipients of incentive payments in order to validate their attestations.4 PCMHs, ACPs, and ACOs Quality and accountable care delivery models are gaining momentum. Already, many hospitals, physician organizations, and payers across the country are scrambling to form ACOs. For example, the first accountable care program in New York City involving a Physician Organization and a Health Plan was announced in January 2012.5 In the announcement, Cigna® said that collaborative, accountable care is the carrier’s approach to accomplishing the same population health goals as ACOs. In late 2011, CMS announced the final list of 32 healthcare organizations from across the nation selected to participate in the new Pioneer ACO initiative.6 Its objective is to encourage primary care doctors, specialists, hospitals, and other caregivers to provide better, more coordinated care for Medicare patients; it’s projected to save up to $1.1 billion over five years. NextGen Healthcare will be working with several of these leading Pioneer ACO organizations to assist them with measuring and reporting the 33 new CMS ACO criteria. The Role of PCMHs in ACOs Technology, staff, and workflow transformation are necessary to achieve Patient Centered Medical Home recognition. This transformation allows health care providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience. With organized patient visits that are documented using HIT tools, providers can more seamlessly and accurately measure outcomes. These elements are an essential foundation for Accountable Care. PCMH measures are nested within the measures published for the Pioneer ACO program, which is reflected in the National Committee for Quality Assurance (NCQA) ACO Accreditation Program.
  5. 5. Building Your ACO and Healthcare IT’s Role | Page 5 At a basic level, the concepts of PCMH and ACO models are very different; however, they both share similar quality-based elements. The PCMH is a model of care delivery, a recognition program for primary care and relevant specialists, and is also an incentive program for providers who meet a level of NCQA recognition (offered by both public and private payers across the country). Continuous quality improvement in care and cost savings are the primary goals. Both healthcare reform models are patient-centered and rely on coordinated care; however, PCMH can be a stepping stone to becoming an ACO. The PCMH model is based on primary care delivering quality health care in close coordination and partnership with all community care partners. Although each PCMH and ACO varies in scope, the two models work hand-in-hand, with a PCMH model acting as a requisite to becoming an ACO. That said, ACOs include and assume that PCMH care delivery models are in place. They further incorporate the concept of multi-provider data liquidity and an enterprise governance structure covering the diverse types of providers. In addition, ACOs utilize population management strategies, as well as specific quality measures and business intelligence tools. NCQA ACO Accreditation Program criteria require that an ACO:7 • Ensures access to and availability of care • Has a solid foundation of patient-centered primary care • Has the necessary care management and coordination capabilities • Monitors practice patterns and uses performance data to improve quality • Utilizes decision support to help patients and providers identify the best care According to a Health Policy Brief published by the Robert Wood Johnson Foundation, an ACO is “an organization, virtual or real, that agrees to take on the responsibility for providing care for a particular population while achieving specified quality objectives and constraining costs.” ACOs are accountable for both quality and cost of care for a defined population. The promise of cost containment is a major driver for payers considering ACO partnerships with physician groups. Care Coordination and ACOs To become an ACO, care coordination in relation to quality is important and necessary. Organizations that do meet these standards will be financially rewarded in order to encourage further improvements in care coordination. Providers will be paid on a fee-for-performance basis with incentives based on certain objectives. The goal of these efforts is to reach a fully-coordinated care delivery system.
  6. 6. nextgen.com NextGen Healthcare contributes to an ACO’s success through the exchange of clinical and financial data across the continuum of care, supporting the ACO’s responsibility to measure, monitor, and manage its participating population. The common driver is that both sides are committed to continuous healthcare improvement and cost reduction. The goals of the “Triple Aim8 ” health reform programs are to: • Improve patients’ experience of care • Improve population health • Reduce overall healthcare costs EHRs and MU – The Root of the Pay for Performance (P4P) Model There is a strong link between MU and the NCQA ACO Accreditation criteria, which supports engaging patients in the wellness and care delivery process. Implementing an EHR system is central to meeting and attesting to the quality measurement criteria. Eligible professionals and practices can earn Stage 1 MU reimbursements from CMS ranging from $44,000 to $63,750 by demonstrating MU of a certified EHR for: • ePrescribing • Sharing clinical data with other certified EHR systems • Reporting on specified clinical quality measures EHRs drive the capture and reporting of MU data beyond Stage 1 to include the following PCMH/ACO MU attestation requirements: • Drug formulary, drug use, drug allergy checks • Electronic prescribing • Maintaining up-to-date problem list of current and active diagnoses and medications • Recording demographics on preferred language as well as gender, race, ethnicity, and date of birth • Recording and charting changes in vital signs • Recording smoking status • Reporting ambulatory quality measures NextGen Healthcare clients are earning CMS MU incentive revenue, and are establishing PCMH and ACO organizations, using the following NextGen Healthcare core products: Certified NextGen® Ambulatory EHR, Certified NextGen® Inpatient Solutions; NextGen® Patient Portal, NextGen® Health Quality Measures, NextGen™ Health Information Exchange, and a built-in ePrescribing module.
  7. 7. Building Your ACO and Healthcare IT’s Role | Page 7 How NextGen Healthcare Supports PCMH, NCQA Recognition Levels 1−6 NextGen Healthcare is constantly re-evaluating and upgrading processes to provide value and results to clients. Hospitals, practices, and physicians establish a NextGen Healthcare partnership based on our track record and the value clients get from our knowledge and technologies. We ensure our clients are prepared and successful in supporting new aspects of payment reform and quality measurement. Helping our clients meet NCQA Standards to establish PCMH and/or ACO status is a major focus for NextGen Healthcare in 2012 and beyond. Current NCQA PCMH: 6 Standards, 27 Elements, 149 Factors step1 step5 35–59 points and all six must-pass elements 60–84 points and all six must-pass elements 85–100 points and all six must-pass elements level1 level2 level3 THE POINT ALLOCATION FOR THE THREE LEVELS OF PCMH
  8. 8. nextgen.com Summary of Current NCQA PCMH Standards9 There are a total of six PCMH standards that participants achieve and combine to reach one overall score. Each standard consists of several specific elements. Standards evaluate a practice’s ability to function as a patient- centered medical home (PCMH). The following table provides a content requirement summary for each of the six PCMH standards along with NextGen® solutions available to achieve each standard. PCMH STANDARD PCMH CONTENT ELEMENTS OF ACO PCMH 1: Enhance Access/Continuity PCMH 2: Identify/Manage Patient Populations PCMH 3: Plan/Manage Care Patients have access to culturally and linguistically appropriate routine/urgent care and clinical advice during and after office hours The practice provides electronic access Patients may select a clinician The focus is on team-based care with trained staff The practice collects demographic and clinical data for population management The practice assesses and documents patient risk factors The practice identifies patients for proactive reminders The practice identifies patients with specific conditions, including high-risk or complex care needs and conditions related to health behaviors, mental health or substance abuse problems Care management emphasizes: Pre-visit planning Assessing patient progress toward treatment goals Addressing patient barriers to treatment goals The practice reconciles patient medications at visits and post-hospitalization The practice uses e-prescribing Patient/caregiver experience Preventive health At-risk Populations (diabetes, hypertension, ischemic vascular disease, heart failure, coronary artery disease) Patient/caregiver experience At-risk Populations (diabetes, hypertension, ischemic vascular disease, heart failure, coronary artery disease) NEXTGEN® SOLUTION NextGen® Practice Solutions NextGen Ambulatory EHR NextGen Patient Portal NextGen® Dashboard NextGenTM Consulting Services NextGen® Mobil 2.2 NextGen Ambulatory EHR NextGen Health Quality Measures NextGen Dashboard NextGen Health Information Exchange NextGen Ambulatory EHR NextGen Health Information Exchange NextGen Inpatient Solutions Lab Pharmacy integrated or third party
  9. 9. Building Your ACO and Healthcare IT’s Role | Page 9 The Power of Data Integration Data integration from disparate stakeholder sources throughout the healthcare ecosystem is the “final state” objective of the HIT revolution. Multiple source data reciprocity — fully reliable, accurate, transparent, and secure data integration to and from every healthcare stakeholder – isn’t a reality today. However, it is the HIT foundation – information as a service – that supports collaborative care coordination within a fully-functioning community. As the shared risk payment model between physicians and payers matures, healthcare providers will be required to quickly and easily aggregate current and past information about a patient’s health – from the patient’s entire continuum of care, in order to: 1. Support decisions at the point of care 2. Empower the patient to engage with their care team 3. Assist patients in executing the latest care plan created for them by their physician 4. Coordinate care across the ecosystem PCMH STANDARD PCMH CONTENT NEXTGEN® SOLUTION PCMH 4: Provide Self-Care Support/ Community Resources PCMH 5: Track/Coordinate Care PCMH 6: Measure/ Improve Performance The practice assesses patient/family self-management abilities The practice works with patient/family to develop a self-care plan and provides tools and resources, including community resources Practice clinicians counsel patients on healthy behaviors The practice assesses and provides or arranges for mental health/substance abuse treatment The practice tracks, follows up on and coordinates tests, referrals and care at other facilities (e.g., hospitals) The practice manages care transitions The practice uses performance and patient experience data to continuously improve The practice tracks utilization measures such as rates of hospitalizations and ER visits The practice identifies vulnerable patient populations The practice demonstrates improved performance NextGen Consulting Services Physician Resources Services Patient Portal Community NextGen Health Information Exchange NextGen Ambulatory EHR Disease Management NextGen Health Quality Measures NextGen Dashboard NextGen Consulting Services NextGen Practice Solutions NextGen Ambulatory EHR NextGen Health Quality Measures NextGen Patient Portal NextGen® EHR Connect NextGen Ambulatory EHR NextGen Health Quality Measures Medication Management HQM ELEMENTS OF ACO Patient/caregiver experience Patient/caregiver experience Care coordination/patient safety At-risk Populations (diabetes, hypertension, ischemic vascular disease, heart failure, coronary artery disease)
  10. 10. The Must Have — Interoperability True clinical integration of patient care around PCMH and ACO models requires HIT interoperability with other organizations. To successfully connect disparate technology systems — while reaping the associated benefits of controlled data flow, decreased costs, and reduced errors — providers need a powerful and proven HIE solution. A robust HIE/Data aggregation strategy is needed to support interoperability and a clinically integrated structure. NextGen Health Information Exchange – Private The goal of HIE technology is to facilitate access to, and retrieval of, clinical data for enhanced patient care. With an HIE, providers are able to mobilize healthcare information electronically across organizations within a community, a region, or across the country. HIE provides the capability to electronically move clinical information among disparate healthcare information systems while maintaining the meaning and security of the information being exchanged. NextGen Healthcare Enterprise Non-Affiliated System Pharmacy System Ambulatory EHR Hospital Laboratory System Patient Portal
  11. 11. Building Your ACO and Healthcare IT’s Role | Page 11 Evolution of Participation — Shared Savings Model Criteria10 The Shared Savings Model (SSM) – also referred to as the “Shared Risk Payment Model” – seeks to reduce fragmentation in care delivery, improve overall patient population health, and lower healthcare costs. Providers will need to work cooperatively across the healthcare continuum to overcome siloed care delivery, treat patients effectively, and help them stay healthy. 3-5 Year Process PM System PRACTICEREDESIGN FINANCIAL MODEL EHR and Registry CLINICAL QUALITY PROGRAM Patient Portal and HIE ESTABLISH MEDICAL HOME Automated Patient Outreach and Physician Mobile Solution CONTRACT P4P WITH PAYERS Enterprise Performance Management ENGAGE IN ACO OR SHARED SAVINGS MODEL ststepep11 ststepep22 ststepep33 ststeepp44 ststeepp55 ADOPTION CURVE Reports vary widely on how long it will take providers to establish ACO or SSM practices. Part of the value that NextGen Healthcare and the NextGen Healthcare network can provide to clients and prospects is to educate them about the ACO/SSM adoption process. NextGen Healthcare provides guidance and recommendations about the specific challenges, opportunities, and tools required for success at each step of the build process.
  12. 12. nextgen.com NextGen Healthcare Core Products Support the Functional Pillars of an ACO NextGen Healthcare provides the technology systems to help healthcare providers build a successful PCMH and ACO. Clients can use our systems to create the functional pillars of an ACO including development of an HIE; establishing medical home practices; quality patient outreach; reporting and compliance; financials and analytics; claims; patient management; administration; clinical data; registries; and continuous documentation improvement. Our clients’ ability to successfully implement these initiatives is supported by NextGen Healthcare’s Solutions Foundation which includes our core products. The NextGen Healthcare Solutions Foundation HIE and Portal Medical Home Practices Patient Outreach and Mobile Quality Reporting and BI Financials and Analytics Claims/Clinical Functional Pillars of an Accountable Care Organization NextGen Healthcare Foundation Accountable Care Organization Meaningful Use Stages NextGen Ambulatory EHR NextGen Practice Management NextGen Inpatient Solutions NextGen Health Information Exchange NextGen Patient Portal NextGen Population Management BI/ NextGen Dashboard NextGen Health Quality Measures NextGen Consulting Services NextGen Healthcare provides the tools and systems needed to help providers evolve through MU on the way to an ACO delivery model with minimal disruption to their practices. The NextGen Healthcare Solutions Foundation provides the technology, systems, infrastructure, and training required for the transition regardless of where practices and physicians currently find themselves in the process.
  13. 13. Building Your ACO and Healthcare IT’s Role | Page 13 NextGen Healthcare Solution Evolution – Interoperable and Scalable n Managemen t INPATIEN T AM B ULATORY EHR PM nnnn AAAAMMM BBBBB UUUULLLAAAAALL TTAA OOORRRRRRYYYYYRR EHRR PPPPPMMMMPMMMM nnnnaaggemmmmmmmeeeeeennnnn tttt IIINNNNNNNPPAAPPP TTTTAAA IIIIIEEEEEENNNNNN TTTT MMMMMMMMMMMaaaannn TARGET CO M MUNICATE TRACK AND MEASURE There are several products and capabilities necessary to support Meaningful Use, 2012 NCQA PCMH, and Accountable Care constructs. Each NextGen Healthcare product supports interoperability and is scalable for the single practitioner to a multi-hospital integrated delivery network. The NextGen Healthcare vision includes our commitment to provide flexible, integrated solutions across the entire continuum of care.
  14. 14. nextgen.com NextGen Healthcare Product Portfolio Supporting Specific MU/PCMH/ACO Criteria As the core of MU, PCMH, and ACO – the EHR provides the foundation and functionality for practices to achieve Level 3 PCMH recognition. An EHR satisfies not only Meaningful Use requirements, but also provides a long-term solution for the provider’s specialty, workflow, reporting, and other clinical and business needs. The ultimate goal of providers who harness the power of electronic health records (EHRs): Create and share vital patient data across the continuum of care, in real time, and within existing workflows. Also, PCMHs and ACOs require tools that support population management to enable providers to focus on patients with chronic conditions. Beyond simple data exchange the EHR enables providers to improve: • Provider workflow • Care coordination • Patient safety NEXTGEN HEALTHCARE PRODUCT SUPPORTING FUNCTIONALITY NextGen Practice Solutions NextGen Ambulatory EHR and Registry A solid practice management system is required to reconcile current costs and contracts with payers. Through a registry and an EHR system, the practice can assess progress in meeting several quality measures. NextGen Patient Portal and NextGen Health Information Exchange NextGen® Population Management NextGen Health Information Exchange Practices should select an EHR that supports PCMH and ACO with strong case management and referral management. Physician practices should plan to implement a patient portal and either join a Health Information Exchange (HIE) or form one of their own so they can collaborate with other physicians with clinical patient data integration. Providers need an intelligent population management strategy to engage in quality programs and proactively reach out to their patient populations to schedule non-compliant patients for recommended care. Medical practices will need to partner with hospitals, rehabs, skilled nursing facilities, and home health providers to imple- ment results-oriented, integrated care solutions and improved outcomes for individuals, their families, and their local health system. More advanced portals offer the ability for a physician and a patient to engage online for E-visits and consultations. Advanced portals also support connectivity with home health devices – allowing physicians to access and understand “current state conditions” of their client base.
  15. 15. Building Your ACO and Healthcare IT’s Role | Page 15 In addition, with NextGen Dashboard, providers can access essential information quickly and easily, and display it in an easy-to-interpret, colorful, and graphical format. If greater detail is needed, providers can drill down from one level to the next with the click of a mouse. This provider-based tool can create graphic images that reflect the priorities of the entire practice or of a single provider. Dashboard, a Practice Performance Snapshot Third Party Population Management Dashboard Layer Care Management InSight Reporting™ HQM Regulatory Data Repository Equipped with multiple pre-programmed charts, NextGen Dashboard is ready to go at installation, and with its easy-to-use interface, users can quickly create and save their own personal charts.
  16. 16. nextgen.com NextGen Healthcare and our consultant partners work collaboratively to deliver timely and relevant HIT solutions to our clients. PCMH-ACO, financial performance, care collaboration, and cloud computing are key initiatives we are targeting. HospitalA EmergencyDepartment PCPPhysicianPractice Med/Surg/Specialties HomeHealth SkilledNursingHome ExternalLabImaging Pharmacy Therapies MentalBehavioralHealth SocialService/CaseMgmt Payer Person/Patient ACO Organization Governance/Leadership ACO Participant Business Operations with IT Alignment Governance Program Management Communications Care Coordination Quality NextGen Healthcare supports the ACO market requirements by providing the platform and tools to enhance sharing and data integration across the spectrum of healthcare stakeholders. Above are the current structural requirements of an ACO according to the CMS final rule. ACO Market Requirements11
  17. 17. Building Your ACO and Healthcare IT’s Role | Page 17 ACO Structural Criteria ACO Payers and Medicare Financial Models Payer/provider shared-risk models are in the early developmental stages. The four basic payment risk-sharing models are illustrated below.12 ACO Payers and Medicare Financial Models NextGen Healthcare and Partner Consulting Services ACOs are a departure from the status quo and are an ambitious goal for even the most advanced healthcare systems. But the trend is unstoppable. NextGen Healthcare’s goal is to deliver a completely seamless integration of solutions across all NextGen Healthcare products. We believe that the only way we can authentically assist our customers to achieve functioning ACO status is by presenting a broad, flexible, integrated offering across every stakeholder function in the healthcare ecosystem—and the knowledge to leverage it. We are doing this with strategic planning and tactical execution while simultaneously providing project management and supplemental staffing as projects and phases are implemented. Our in-depth knowledge in EHR, practice management, and acute care workflows and processes will result in significant quality improvements for our clients and a considerable ROI for our consultant network. MEDIMEDICCAREAREPRIVATE INSURER EMPLOYER Risk Sharing Bonus Payment Market Share Baseline Revenue Loss Patient Population Provider at risk of not receiving a bonus payment based on quality and/or efficiency performance Patients given lower copays or premium incentives to select specific providers, risk losing market share Providers face a financial or payment loss if they fail to meet certain cost or quality thresholds, and/or if actual costs exceed a target cost Providers manage patient treatment costs for all or a designated set of services within a predetermined payment stream and are at risk for costs that exceed payments
  18. 18. nextgen.com The Industry’s Vision Data Exchange, Interoperability, Integration, and Seamless, Secure Access for All Robust and secure data exchange to external and community information systems at hospitals, labs, pharmacies, payers, public health, health information exchanges, and patient portals is the critical path that will lead to global community health. NextGen Healthcare is synchronized with this vision. We provide our customers and the extended stakeholders within the healthcare ecosystem an innovative solution that supports the patient-centric model of PCMH and ACO healthcare management. NextGen® solutions help our clients align with the journey to global community health. Our client commitment includes working as partners to address the day-to-day challenges of running a successful practice or hospital system. Valued Partnerships As NextGen Healthcare pursues an aggressive agenda in these next years ahead, relationships with clients, prospects, and industry consultants, will be nurtured to enhance our knowledge and technology innovations to educate, support, and deliver solutions of the future. We are convinced that our consultant community and their expansive services portfolio is a critical component for NextGen Healthcare. Together, we can present new opportunities to create business solutions for success to clients who can benefit from our shared expertise. Our consultant network also conveys the accurate and up-to-date market intelligence to craft sustainable business initiatives that position clients for the challenging times ahead. NextGen Healthcare is one of the most highly sought-after HIT solutions companies in the industry. We believe NextGen Healthcare consultants are too. Together NextGen Healthcare and industry consultants are creating new relationships in the market built on thought leadership, superior technology, a track record of success based on proof, and an unwavering dedication to helping our clients meet today’s industry challenges. Final Thoughts The stakes may seem high and the topic of financial solvency is ever-present. The transition involves taking risks, no doubt, but with focus, a strong technology partner and the right tools, providers can establish sustainable health care business practices and a strong business model that will keep their doors open and revenue coming into the practice while they transition to quality care and P4P remuneration. EHRs and other healthcare information tools are essential to accomplishing this transition. By successfully adopting and utilizing these tools, practices are better able to identify high-risk patients, provide more comprehensive care, assess clinical outcomes, earn performance-based compensation, and share information securely both within and outside the practice. Ultimately, the true long-term revenue and practice rewards will be demonstrated in improved patient outcomes driven by real-time access to pertinent clinical patient data, anytime, anywhere.
  19. 19. Building Your ACO and Healthcare IT’s Role | Page 19 Footnotes 1. Diana Manos, “Mostashari: Meaningful use to reach new heights,” Healthcare IT News, 11 Jan, 2012. 2. Neil Versel, “HIMSS chief forecasts ‘seismic shifts’ for health IT,” Healthcare IT News, 03 June, 2011. 3. Manos, “Meaningful use to reach new heights,” 11 Jan, 2012. 4. Marla Durben Hirsch, “5 EHR predictions for 2012,” Fierce EMR, 5 Jan. 2012. 5. Business Wire, “Cigna and Weill Cornell Physician Organization Launch First Accountable Care Program in New York City Involving a Physician Organization and a Health Plan,” 11 Jan. 2012. 6. HHS News Release, “Health Policy Brief: Next Steps for ACOs,” Health Affairs Shared Savings Model http://www.hhs.gov/news/press/2011pres/12/20111219a.html, (accessed 28 March 2012). 7. NCQA, Accrediting Highly-Qualified Accountable Care Organizations, http://www.ncqa.org/LinkClick.aspx?fileticket=SPg8KYWfK1s%3dtabid=1312 (accessed 28 March 2010). 8. “Donald M. Berwick,” “Health Affairs,” The Triple Aim: Care, Health, And Cost (online; Health Affairs, abstract, May 2008, 27), http://content.healthaffairs.org/content/27/3/759, (accessed 28 March 2012). 9. NCQA, “Patient-Centered Medical Home,” PCMH Content and Scoring Summary, http://www.ncqa.org/tabid/631/Default.aspx, (accessed 28 March 2012). 10. HHS News Release, “Health Policy Brief: Next Steps for ACOs,” (accessed 28 March 2012). 11. CMS, “ Overview,” What’s an ACO? http://www.cms.gov/aco, (accessed 28 March 2012). 12. The Common Wealth Fund, “Newsroom Payment Reform,” Experts Believe Lack of Incentives and Financial Interests Are Barriers to Integrated and Accountable Care, www.commonwealthfund.org/Publications/ FundReports/2011/Jul/Promising-Payment-Reform.aspx, (Accessed 28 March 2012).
  20. 20. SSP EHR PM NCQA MSR P4P HEDIS ON ACO SSP EHR PM NCQA MSR P4P HED MU ACO SSP EHR PM NCQA MSR P4P H CMS MU ACO SSP EHR PM NCQA MSR PCMH CMS MU ACO SSP EHR PM NCQ 1,2,3 PCMH CMS MU ACO SSP EHR PM els 1,2,3 PCMH CMS MU ACO SSP EHR Levels 1,2,3 PCMH CMS MU ACO SSP EH HQM Levels 1,2,3 PCMH CMS MU ACO HIE HQM Levels 1,2,3 PCMH CMS MU A ONC HIE HQM Levels 1,2,3 PCMH CMS DIS ONC HIE HQM Levels 1,2,3 PCMH C HEDIS ONC HIE HQM Levels 1,2,3 PCMH P4P HEDIS ONC HIE HQM Levels 1,2,3 P MSR P4P HEDIS ONC HIE HQM Levels 1 NCQA MSR P4P HEDIS ONC HIE HQM L PM NCQA MSR P4P HEDIS ONC HIE HQ NextGen Healthcare Information Systems, Inc. 795 Horsham Road, Horsham, PA 19044 p: 215.657.7010 | f: 215.657.7011 sales@nextgen.com | nextgen.com Copyright © 2012 NextGen Healthcare Information Systems, Inc. All rights reserved. NextGen and NextPen are either registered trademarks or trademarks of NextGen Healthcare Information Systems, Inc. in the United States and/ or other countries. All other names and marks are the property of their respective owners. Patent pending. SFS-0001_04/12a QSI company