Accountable Care Organization (ACO) Management Tools - FAQ

Accountable Care Organization (ACO)
Management Tools - FAQ
Contents
1. What does an ACO need to support care coordination? ............................................................ 1
2. What tools are needed to support patient centeredness? .......................................................... 2
3. Does an ACO need different tools than a PCMH? ........................................................................ 3
4. What tools does an ACO need to manage risk? .......................................................................... 3
5. How can IT help deal with the unknowns of the ACO model? .................................................... 4
6. What are the key challenges ACOs face in redesigning care processes? .............................. 5
7. How can IT help with the ACO’s care process redesign challenge? ........................................ 5
8. What technologies can help ACOs redesign their care processes? ......................................... 6
9. What are the unique organization management needs of an ACO? ........................................ 6
10. What does an ACO need to do to engage patients? ............................................................... 7
11. How to Measure Patient Engagement and Patient Centeredness? .......................... 9
12. What are some of the tools that support patient engagement? .................................... 11

1. What does an ACO need to support care coordination?
• Longitudinal/Community Health Record – The ACO platform should be based on longitudinal
patient record (i.e., no matter where the patient is being treated, there is one overarching
longitudinal record). While there will be local records in each episode of care (e.g., Home Care,
Acute Care, Ambulatory Care), the ACO platform should be able to pull and aggregate data from the
entire continuum.

• EMPI – The Enterprise Master Patient Index (EMPI) provides the indexing reference for all patients
known to the organization. It is able to match multiple identifiers across disparate and diverse
systems. The EMPI must use multiple matching logarithm methods to try and identify patients with
multiple identifiers.

©2011 Healthcare Information and Management Systems Society (HIMSS) Page 1

• Health Information Exchange (HIE) - The HIE allows multiple care providers and stakeholders in a
community to share patient data in a secure, confidential manner. Data from multiple sources is
collected and exchanged based on interoperability standards. The HIE should include a semantic
mapping framework that enables discrete data elements to be harvested and presented in custom
displays for clinical review at the point of care, for analytics and to meet the requirements of
meaningful use.

• Hierarchical Data Security - The system should allow for a multi-layered, configurable role-based
security model to ensure compliance with privacy and confidentiality regulations. Access to patient
records can be based on a region, organization, clinical care team, provider, etc., using role-based
access. All data exchanged is in encrypted form. Every field in the database can be audited. In
addition the platform should include break-glass functionality to get temporary emergency access to
data such as mental health or communicable disease data.

• Collaborative Clinical Decision Support – This is the ability to access the data collected in the Health
Information Exchange with added chronic disease management tools to be able to provide
community-based information to providers as they deliver care. For example, in the case of a
diabetic patient, at the point of the care, the virtual care team, including the PCP, endocrinologist,
dietician, physical therapist, and patient all have access to up-to-date information, including the last
blood sugar reading and the HbA1C level. In addition, the provider has data on the specific care plan
to be followed for this patient.

• Provider-to-Provider Communication Tools - Examples of this include secure provider-to-provider
email as well as an ability to send out clinical alerts. The clinical alerts would inform a specific
caregiver or team of caregivers about an elevated lab result, a change to a patient’s medication, a
recent MRI report, etc., in a secure fashion.

• Integrated Workflow Management – As part of the platform and its team-based approach and
Collaborative Clinical Network Management functionality, all members of the care team can be
following a care plan for a given patient in which all members of the care team have access to all
information on that patient in a secure fashion with role-based access.

• Active Care Management - Active care management utilizes (evidence-based) care protocols or
pathways to notify all the participants involved in care delivery, including the patient, of their roles
and responsibilities and required interventions. On-going assessment and analysis of service
interventions, clinical and disease markers enable automated feedback to modify specific care
delivery tasks, and recommend changes to improve care protocols or pathways.

2. What tools are needed to support patient centeredness?
The ACO Platform should be based on a longitudinal patient record model (i.e. no matter where the
patient is being treated, there is one overarching longitudinal record). While there will be local
records in each episode of care (e.g., Home Care, Acute Care, Ambulatory Care), the ACO platform
should be able to pull and aggregate data from the entire community. The ACO platform should
enable all stakeholders, including patients, to get consistent and comprehensive information about
their care.


3. Does an ACO need different tools than a PCMH?
Patient Centered Medical Homes and ACOs are not competitive. They are complementary. PCMH
can operate within an ACO structure. In this context, most tools needed by a PCMH will also be
useful for an ACO. In some cases, ACOs will need additional functionality from the same tools. In
other cases, ACOs will need additional tools.

The table below summarizes the different tools and their use between these two models:

Tool PCMH ACO
Electronic health record (EHR) Primary practice EHR may be Longitudinal/community is
sufficient if data from care highly recommended, including
team can be integrated enterprise master patient index
(EMPI)
Health information exchange Preferred but not necessary May be necessary to populate
longitudinal EHR
Clinical decision support Tools integrated with practice Must be collaborative and
EHR may be sufficient shared across the organization
Care management Passive data sharing may be Active tools are highly
sufficient preferable
Quality reporting Provider-centric Population-centric
Clinical analytics Support continuous quality Support continuous quality and
improvement outcomes improvement,
including patient and financial
outcomes
Organization management Practice management ACO budgeting/cost accounting;
ACO legal/contract
management; Operational
management with hierarchical
security and functionality

4. What tools does an ACO need to manage risk?
At their core, ACOs are a means for transferring certain risks associated with the costs of care from
payers to providers. A wide variety of payment models based on such risk transfer have been
proposed and tried over the years. These models provide a spectrum of options for ACO
agreements – both on the public (Medicare/Medicaid) and the commercial (private payer) side. To
understand what tools ACOs may need to manage new risks, we need to look at the kinds of risk
ACOs assume.

There are essentially two types of risk healthcare providers may share with payers: technical, or
performance risk, and actuarial or insurance risk. In most pay-for-performance (P4P) programs,
including Meaningful Use, providers are only required to assume performance risks. This is
certainly true when P4P metrics are primarily process oriented (i.e., when providers are evaluated
based on their ability to deliver consistent, recommended care processes). Patient outcomes, if


measured, are typically risk adjusted to protect providers from insurance risk. This, for example, is
the case with the upcoming Medicare Value-Based Purchasing (VBP) Program.

To manage performance risk, ACOs need the tools to manage their performance. Metrics of
performance may vary, but generally include structure, process and outcome measures. Structure
measures may include specific IT tools. For example, the proposed Medicare Shared Savings
Program (MSSP) calls for a certain percentage of providers within the ACO to have adopted
certified electronic health record (EHR) technology.

Process measures are typically tied to evidence-based guidelines. To manage the performance
across their provider network, ACOs need tools to implement guidelines, and to measure and
improve their compliance. EHR technology provides the foundation, but may need to be
augmented with clinical decision support and clinical data analytics tools.

To manage patient outcomes, ACOs must also provide coordinated, patient-centered care. ACOs
need tools to coordinate care, manage care transitions, manage medications and engage patients.
Clinical data analytics tools need to provide reports that cover patients through the continuum of
care. This implies EHR interoperability across the ACO network. Health information exchange (HIE)
technology may be needed to integrate patient data within the provider network and beyond. A
consolidated clinical data repository should be considered as the foundation for the analysis of care
patterns and quality reporting. Disease registries may also be used to cover specific patient
populations. Population health management tools will help ACOs design care protocols to improve
patient outcomes.

The Medicare Shared Savings Program (SSP) goes a step beyond P4P. To succeed under this
program, ACOs must reduce the average cost of care under a predetermined benchmark. In this
case too, risk adjustment is designed to protect providers from insurance risks. But beyond
performance risk associated with achieving patient outcomes, this program requires providers to
assume risks for cost. This implies that ACOs need tools to manage resource utilization. Ideally,
these tools will be integrated with the analytical tools mentioned above. Initially, providers may
work with payers to share the same tools payers are using for utilization management.

It is only in the absence of risk adjustment or with capitation payment models that ACOs will be
required to assume full risks for the cost of care, including insurance risks. To do that, ACOs will
need the toolset of managed care organizations. For most ACOs, this will not be a viable option in
the early stages.

5. What IT strategy can help deal with ACO unknowns?
The health reform law has left many unknowns around the ACO model. Some of these are expected
to clear over time. Yet other unknowns may purposely remain to allow for market innovation.
Indeed, well ahead of the pilot demonstration projects mandated to begin by 2012, many private
payers, provider groups and associations have already proposed or launched pilot projects. Models
for these pilots vary greatly. Such great variation and flexibility in the ACO model implies the need
for elasticity and agility in the ACO strategic plan, which in turn suggests that the same qualities will
be required of its IT infrastructure.


ACOs should develop an IT strategy that enables them to respond quickly and effectively to
changing market requirements and dynamics. Interoperable, standards-based systems will allow
ACOs more choice in their selection of IT vendors and applications. In the next few years, ACOs
should consider best-of-breed solutions to cover gaps in their current IT infrastructure. Many of the
tools needed to succeed under the ACO model will also support other value-based payment
models. As they build their IT infrastructure, ACOs should consider foundational tools that will
benefit their members across multiple programs and payment models.

6. What are the key challenges ACOs face in redesigning care processes?
As the care delivery system shifts from volume to value-based payment, ACOs are called upon to
redesign care delivery around these new metrics. This is a tall order. To succeed, ACOs must
embark on a journey very few healthcare organizations have attempted. And even the few who
have – mostly large integrated delivery systems – can provide little useful evidence to the vast
majority of our healthcare system, consisting of small uncoordinated fragments. Moreover, the
scientific evidence base to guide this journey is highly incomplete, especially when it comes to cost.

To meet the care process redesign challenge, ACOs must address multiple dimensions, including:

• Reducing variation and disparities in care delivery among practices and individual
providers, i.e. standardizing care.
• Identifying the most effective care delivery processes to drive the organization’s
strategic goals.
• Identifying and implementing effective interventions to standardize care around the
desired processes.
• Leading cultural and behavioral change initiatives necessary to drive organizational
change.
• Developing a culture of learning and innovation that fosters on-going improvement, and
the consumption, distillation and dissemination of best practices.
• Centering care on patients and engaging them in the management of their own health.

7. How can IT help with the ACO’s care process redesign challenge?
In their core function as agents of change, ACOs can find their best allies in information and the
technologies that manage it. Recent events around the globe, such as the popular ousting of long-
time rulers in North Africa, have provided dramatic and poignant proof of how information and
technologies that facilitate its sharing on a massive and egalitarian basis can impact public opinion
and affect drastic change. The same underlying principles are applicable to the ACO’s strategic goal
of care process redesign and the organizational challenge inherent to it.

Information that drives organizational change starts with data – timely, accurate, relevant and
reliable data. Turning data into information requires technology. Technology enables aggregating
and summarizing data. It supports analyzing data to identify actionable information. Technology
allows visualizing data to drive action. With technology, data can be mined to gain new insights.
Technology enables measuring performance and outcomes. Technology supports coordination and


collaboration. And it is through technology that knowledge can be most effectively collected and
distributed.

8. What technologies can help ACOs redesign their care processes?
To achieve their strategic goals, ACOs will need myriad IT tools. Many of these technologies are not
new. They have been tried and proven in other industries. Some of them have been adopted in
healthcare. But for the most part the application of these technologies to the ACO care process
redesign challenge is new. And applying these tools to improve patient care will require breaking
new ground. Among these technologies are the following:

• Data analytics/business intelligence (BI) – Payers have used these tools for years to
leverage claims data to manage health insurance risks more effectively. Some payers
have even spun off businesses based on predictive modeling and data mining
techniques. Many hospitals have used traditional BI tools to better manage their
operations and finances. For ACOs, a new and exciting prospect is the integration of
clinical data into these technologies. Arguably, such clinical business intelligence will be
a critical success driver for ACOs.

• Process management – Care delivery organizations have long applied process
management methodologies to their business processes, such as supply chain and
revenue cycle management. But the introduction of techniques like total quality
management (TQM) to the process of care itself is relatively new and not commonly
used today. To succeed in their mission to redesign care processes, ACOs will do well to
adopt such technologies to their full potential.

• Decision support – While many clinical decision support tools, such as order sets,
medication safety alerts, etc., are already in use today, few healthcare organizations
have adopted comprehensive and integrated decision support toolsets. Without such
toolsets, however, ACOs have little hope of standardizing care even in those areas
where standardization is highly desirable.

• Knowledge and learning – Perhaps more than any other industry to undergo process
redesign to date, healthcare faces this dual challenge: while medical knowledge is
growing exponentially, much uncertainty remains along the care delivery process.
Successful ACOs (and any healthcare providers) must embrace tools to manage and
apply knowledge from both outside and internal sources and promote learning at both
the individual and organizational levels.

• Collaboration – Beyond the care coordination tools described above, collaborative
technologies can help ACOs identify, distill and disseminate best practices within their
network and across ACO networks. More than any other tool, collaborative technologies
can accelerate the transformation required of ACOs.

9. What are the ACO’s unique organization management needs?
Budgeting & Cost Accounting


Creating and operating an ACO can be more complicated than a traditional provider organization.
Planning, upstart costs, arranging relationships with partners, interfaces to partner systems,
staffing increases, expanding owned interests, and coordinating contracts, payments, and shared
savings are just some of the major concerns that will require additional budgeting and cost
accounting. In particular, payments to partners can be complex.

Contract & Legal Management
ACOs by their nature will require contracting with a broad range of partners with varying degrees
of affinity. From close to loosely affiliated partners, contracts and legal management will be
required. It’s also likely that ACOs will have to continually evolve to address changing business
conditions, regulations, competition, payment reform and population health. As such, some
partnerships may decrease or terminate while new ones may start or grow. Terminating
partnerships early may lead to penalties. Partner organizations that do not meet their goals may
also need to be pursued from a legal perspective to recoup costs, collect penalties, etc. In short,
ACOs will be complex businesses with complex legal needs.

Operational Management
Running an ACO on a day-to-day basis will require a firm handle on revenue, expenses, resources,
timing, etc. Provider organizations not experienced with managing risk and patient populations will
need new skills and systems. Meeting reporting requirements, managing partners, ensuring
government compliance, and doing so all in a timely fashion that meets stringent regulations and
oversight will be key.

Network Capacity
They say that the biggest challenge for any business can be dealing with “success” – scaling up to
new volumes and demands – while meeting customer and partner expectations. How big an ACO
can grow in a fashion that is sustainable and meeting the needs of key stakeholders must be
considered.

Operational Benchmarking
Any business can be compared on a relative and absolute scale. Particularly in the case of ACOs
where success and shared savings will be based on comparison to peers, it will be crucial to
understand how the organization stacks up. Success will require pushing into new areas of
performance, including quality-based, speedier, cost-effective and innovative care. Benchmarks
are a solid approach for comparing to others, and along with metrics and goals, can help an
organization stay focused on the right direction.

10. What does an ACO need to do to engage patients?
Among the requirements of Medicare ACOs are the following:

• Create processes to promote evidence‐based medicine and patient engagement, report on
quality and cost measures and coordinate care using telehealth, remote patient
monitoring, etc.; and


• Meet patient‐centeredness criteria such as the use of patient and caregiver assessments or
individualized care plans.

For the purposes of this discussion we have used the following definitions:

Patient engagement means engagement in one’s own health, care and treatment and involvement
in the design, planning and delivery of health services.

Patient-centeredness is defined as: "Health care that establishes a partnership among
practitioners, patients, and their families (when appropriate) to ensure that decisions respect
patients' wants, needs, and preferences and that patients have the education and support they
need to make decisions and participate in their own care."1

Why is patient engagement important? There is a proven association (Coulter and Ellins 2006)2
between the engagement of patients in their health, care and treatment and the outcomes in
relation to:

• Patients’ recall of information, knowledge and confidence to manage their conditions;
• The likelihood of patients reporting that the chosen treatment path was appropriate for
them;
• Patient reports of their experiences, and of their satisfaction with care; and
• Use of healthcare resources, where engaged patients are more likely to adhere to chosen
courses of treatment, and to participate in monitoring and prevention.

It has also been shown that some interventions to involve patients in sharing the decision over
treatment choice result in patients choosing less interventionist (and costly) treatments than their
clinicians might otherwise have recommended.

Judith Hibbard, a professor of health policy at the University of Oregon, noted patients usually
encounter a one-size-fits-all provider approach when it comes to finding ways for them to manage
their chronic conditions. However, if providers had more information on their patients' abilities to
engage and self-manage their conditions, they might be better able to target and support a
patient's healthcare needs, she said.

"We've found that tailoring support to the patient's level of [engagement] is an important way to
help [patients] become more activated and to be able to do all the behaviors we're asking them to
do," she said.

Hibbard and her colleagues developed a measure to assess skill, confidence, and knowledge among
patients about managing their conditions. With the measurement, they've been able to find new
ways "to actually do a better job of engaging people." The degree of patient engagement in
consultations can be measured through patient experience reports.

ACOs depend on more informed and engaged patients who assume more financial risk to help
meet the goals of lower costs, higher quality, and greater satisfaction. The Internet's advances and
methods for secure access make true patient engagement a reality. ACOs will have to create
portals where patients can access information about their wellness and health status such as lab
results or pharmacy prescriptions, and reliably compare treatments, specialists, hospitals and
costs.


The Society of Participatory Medicine proposes the following processes to promote patient
engagement and centeredness.

Patient engagement
• Working with patients to identify and minimize barriers to timely and effective action by
patients.
• Involving patients with central, meaningful roles in practice improvement efforts, such as
quality improvement teams
• Creating a patient advisory council with adequate resources and meaningful access to ACO
leadership.
• Implementing mechanisms for regular assessment (at least annually) and improvement of
patient engagement standards and processes.

Patient-Centeredness
• Collaborating with patients to ensure that they have the knowledge, skills and support to
make informed decisions about their care as providers and patients work together to
achieve the patients’ aims.
• Maintaining and enforcing policies that ensure the provision of clear explanations and
availability of individuals’ information about their health and healthcare while guarding the
privacy of this data.
• Maintaining and enforcing policies that facilitate and encourage individuals’ full
engagement and participation in their care, but do not require it. Such polices shall
include, without limitation, the following: (a) Offer open scheduling and extended office
hours: (b) Create reminders for patients and providers, delivered by means selected by the
individual; (c) Provide direct patient access to health data; (d) Otherwise use technology as
appropriate to facilitate meaningful patient and family participation in care; and (e) Provide
transparent information about services, their cost, and insurance coverage.

11. How to Measure Patient Engagement and Patient
Centeredness?
While the Institute for Healthcare Improvement (IHI) has defined three objectives of their Triple
Aim strategic initiative (to improve patient experience, the population’s health and medical costs),
the measures used to evaluate progress along those domains have not been prescribed. The IHI
Triple Aim prototyping participants around the world have each developed individual approaches
to establishing their Triple Aim measures of success.


Managed care organizations have signiﬁcant experience with understanding the needs of
their patient populations. Using a variety of analytic techniques, managed care leaders
continuously assess the costs of care, quality of care metrics, and the relative efﬁciency and
quality of care provided by individual providers.

The ACO environment offers an opportunity for leaders to apply lessons learned about
assessing population needs from the managed care experience. In addition to assessing
needs through claims and EHR data, leaders must gather relevant information to allow
them to understand the language, cultural, and social needs of the ACO population. Only
by understanding the true needs of the population can ACO leaders prioritize the activities
that will have the most impact on improving the health of the population.

The National Healthcare Quality Report (NHQR) tracks four measures of the patient experience of
care. The core report measure is a composite of these measures: (1) patient assessments of how
often their provider listened carefully to them; (2) explained things clearly; (3) respected what they
had to say; and (4) spent enough time with them.

In addition, the 2007 NHQR presents four composite supplemental measures from the Hospital
Consumer Assessment of Healthcare Providers and Systems (H-CAHPS), the hospital version of
CAHPS® that focus on the quality of communication that patients experience during their hospital
stay. This is important not only because effective patient-provider communication can help ensure
that medical decisions are consistent with the patient's needs and preferences, but also because
patients can help providers avoid problems with medications and problems that may arise after
they are discharged.

The NHQR includes one core measure of patient centeredness—a composite measure on the
patient experience of care—and two new supplemental measures. Because having a diverse
workforce of healthcare providers may be an important component of patient centered health-care
for many patients, the report includes a new supplemental measure of workforce diversity—
race/ethnicity of the nation's registered nurse (RN) workforce. A supplemental measure focusing
on health literacy of U.S. adults is also presented.

Measuring Patient Engagement / Satisfaction


The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are widely
used, rigorously designed, and available in formats that can be used to assess a variety of
experiences, including inpatient stays, home healthcare, interactions with health plans, and
accessing pediatric care. Of the available surveys of patient satisfaction across the continuum of
care, only the CAHPS instruments have been widely used and have benchmarking data available.
For more information, see Press Ganey surveys, Consumer Assessment of Healthcare
Providers and Systems (CAHPS) surveys and/or the Health Resources and Services
Administration’s Health Center Patient Satisfaction Survey [http://bphc.hrsa.gov/patientsurvey].

12. What are some of the tools that support patient engagement?
1. Individualized care plans are established processes in place to include patients and their
family members as part of the care team and to ensure that care plans are customized for
the individual’s needs and desires. Individualized care plans:

• Ensure that the patients’ needs (e.g., readiness for change) are understood and
that their personal goals and values are taken into account.
• Ensure that both general health goals (e.g., relief of depression symptoms) and
clinical goals (e.g., normalizing blood pressure) are integrated into the care plan and
prioritized according to the patient’s values.

A template for an individualized care plan can be embedded in the EHR and shared with the
patient either in hard copy or electronically. Care management systems that can pre-populate a
draft care plan with recommended goals and an action plan; can be designed to
incorporate data from a variety of sources (e.g., lab data etc.) and use clinical logic to
prioritize risk factors. Ideally, individualized care plans are member-centric, not provider-centric,
and are thus are shared across a health system so each patient has one care plan.

2. Patient decision support system involves having mechanisms in place for patients to
access comprehensive information about their condition and treatment options and to
receive help in discerning and communicating their preferences and values. Such systems
need to use existing tools within the healthcare system as part of a proactive, creative process
to engage patients in their healthcare through a variety of tools and approaches (e.g., reminder
systems, protocols for follow-up, action steps used to shift people’s thinking about their care,
outreach by social workers and case managers, increasing transparency with a patient’s individual
health information).

3. Patient portal for electronic information access via the Internet to a wide variety of
information provided centrally by the ACO; provides people with access to several of the
other operating activities within the people-centered foundation. One of the most
important barriers to the use of patient portals is lack of access to or comfort with electronic
media. For this reason, signiﬁcant marketing efforts are needed to achieve uptake. Portals
associated with health plans have historically had exceptionally low adoption rates, possibly
due to the tendency for consumers to distrust health plans. Some of the patient portals
crafted by health plans have excellent functionality and—despite the low uptake rates—may
be useful prototypes for ACO leaders to consider.


Connection should be made with the communication and marketing departments of the
healthcare systems, payers and employers to develop a patient portal that will best engage
patients and to create messages that promote the understanding that the goal of
people-centered care within the ACO is to give people more control, not to shift all
responsibility from providers or restrict access to needed care.

4. Personal health record (PHR) is a computerized application that stores an individual's
personal health information and provides the mechanism for access to that information. The PHR
includes a record of a patient’s healthcare experience built from EHR, claims data, and
other sources of information. One of the principle distinguishing features of a PHR is the
platform by which it is delivered. The types of platforms include: paper, personal computers, the
internet, and portable devices.

References

Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, Health, and Cost. Health Affairs, vol
27 no.3, 2008; 759-769.

Berwick DM. What 'Patient-Centered' Should Mean: Confessions of an Extremist. Health Affairs, vol
28 no. 4, 2009; 555-565.

Coulter A, Ellis J. Patient Focused interventions. A review of the evidence. Picker Institute Europe.
2006.

Dixon A, Greene J, Hibbard J. Do Consumer-Driven Health Plans Drive Change in Enrollees’ Health
Care Behavior? Health Affairs. 2008; 1120-1131.

Fendrick AM, Chernew ME. Value-based Insurance Design: Aligning Incentives to Bridge the
Divide between Quality Improvement and Cost Containment. American Journal of Managed Care.
Vol 12, 2006; SP5 - SP10.

Hibbard JH, Greene J, Tusler M. Improving the Outcomes of Disease Management by Tailoring Care
to the Patient's Level of Activation. American Journal of Managed Care. No. 6,June 15, 2009; 353 -
360.

Hibbard JH, Cunningham PJ. How Engaged Are Consumers in Their Health and Healthcare, and
Why Does It Matter? Washington, DC: Center for Studying Health System Change. 2008.

Institute for Healthcare Improvement. The Triple Aim- Optimizing health, care and cost. Healthcare
Executive. Vol 24 no. 1, Jan/Feb 2009; 64-66.

Institute of Medicine. Envisioning the National Health Care Quality Report. Washington, DC:
National Academy Press. 2001.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The Quality of Health Care
Delivered to Adults in the United States. New England Journal of Medicine. Vol 348 no.26, June
2003; 2635 - 2645.


Mittler JN, Landon BE, Fisher ES, Cleary PD, Zaslavsky AM. Market Variation in Intensity of
Medicare Service Use and Beneficiary Experiences with Care. Health Services Research. Vol 45 no.3,
June 2010: 647 – 669.

National Committe for Quality Assurance. The State of Health Care Quality - Value, Variation and
Vulnerable Populations. Washington, DC: National Committe for Quality Assurance. 2009.

Saha S, Beach MC, Cooper LA. Patient Centeredness, Cultural Competence and Healthcare Quality.
Journal of the National Medical Association. Vol 100 no.11,Nov 2008; 1275 – 1285.

Solberg LI, Klevan DH, Asche SE. Crossing the Quality Chasm for Diabetes Care: The Power of One
Physician, His Team, and Systems Thinking. Journal of the American Board of Family Medicine. Vol
20 no.3, 2007; 299 - 306.

Wasson JH, Baker NJ. Balanced Measures for Patient-Centered Care. Journal of Ambulatory Care
Management. Vol 32, no. 1, 2009; 44-55.

Patient activation and engagement metric references:

Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and Testing of a Short Form of
the Patient Activation Measure. Health Services Research. 2005; 40:6: 1918-1930.

Wasson JH, Bartels S. CARE Vital Signs Supports Patient-centered, Collaborative Care. Journal
of Ambulatory Care Management. 2009; 32(1): 56-71.

Safran DG, Karp M, Coltin K, Chang H, Li A, Ogren J, Rogers WH. Measuring Patients’ Experiences
with Individual Primary Care Physicians: Results of a Statewide Demonstration Project. Journal of
General Internal Medicine. 2006; 21:13–21.

Authors

Alan Gilbert VP Business Development, AxSys Technology
Kenneth A. Kleinberg, FHIMSS Senior Director, The Advisory Board Company
Kobi Margolin CEO, Clinigence
Joe Pleasant, FHIMSS Senior VP & CIO, Premier, Inc.
Edna Boone, CPHIMS HIMSS Staff Liaison


Accountable Care Organization (ACO) Management Tools - FAQ

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (12)

Similar to Accountable Care Organization (ACO) Management Tools - FAQ

Similar to Accountable Care Organization (ACO) Management Tools - FAQ (20)

Accountable Care Organization (ACO) Management Tools - FAQ