Health IT and ACOs


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What role does technology play in the growing trend of community-based health care systems? According to the Final Rule for Accountable Care Organizations, Health IT plays perhaps the most important role of them all. Find out more about technology providers and how they influence the ACO incentive programs.

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Health IT and ACOs

  1. 1. Health IT& ACOsAdele Allison,National Director of Government Affairs,SuccessEHS
  2. 2. Health IT is the ACOBackbone. It willcreate Winners andLosers.
  3. 3. Certified EHRAdoption is weightedtwice as much asother performancemeasures.
  4. 4. ACO Health IT exceeds the “meaningful use” of an EHR with IT needs for:• Data Aggregation• Care Coordination (E.g., Referrals) and Population Management• Revenue Cycle Management and Reporting
  5. 5. ACO Tools of the Trade• Membership and Provider Network Management Systems• Prospective and Retrospective Payment Systems• Utilization Trending and Reporting Systems• Patient Portals and PHRs
  6. 6. ACO Tools of the Trade• Patient Survey Tools• ACO-wide and Clinic-wide Digital Dashboards• Business Intelligence Tools• Data Repository• Patient Population Management Systems
  7. 7. ACO Tools of the Trade• EHR-based PQRS (GPRO)• Advanced HIE
  8. 8. ACO Blueprint
  9. 9. Health IT Patient ACO Internal Engagement and External Strategies Governance ACO Leadership Care Coordination Patient- CenteredPhysician-DrivenOperations Care Using Data and Reporting PCMH PCPs and SCPs Continuum of Health Care “In-Network” Referrals
  10. 10. Long-Term ACODecision Points
  11. 11. Extend Valuecreated to otherPayers/Employers
  12. 12. Systems and Processesmust consider:• Participant Performance Metrics• Operations/Data Exchange• Medical Management (E.g., Case Management and Utilization Review)• Provider Contracting
  13. 13. Systems and Processesmust consider:• Product Development/Benefit Design• Marketing and Communications
  14. 14. Requires clearlyidentifiedChampion (E.g.,CMO)
  15. 15. RequiresCommunity-Wide“Buy-in”
  16. 16. Health IT &ACO - Maturity
  17. 17. Beginner
  18. 18. Successful HIT Beginner Requirement Milestone Technology Required ACO Risk and Care Continuum Cost • Membership Accounting for Target Revenue Clinical Events and/or Information Tools • AR Systems Management Chronic Conditions Patient Engagement; • Patient Portals Episode of Care • Patient-SpecificACO Beneficiaries Management; ACO Patient Education Tools Support; "In-Network" • Referral Management Referral Guidance System
  19. 19. Successful HIT Beginner Requirement Milestone Technology Required Provider Network • Case Management ACO Care Development; Case Tools Management; Protocol Management Compliance Tracking and • Population Management ToolsAcross Continuum Provider Utilization • Digital Dashboards Reporting Clinical Read-only access based on • e-Fax Information user request (E.g., fax); • Secure Email Static Information Exchange
  20. 20. Successful HIT Beginner Requirement Milestone Technology Required Data-mining, Non-aggregated and modeling with single-patient focused; • Business Intelligence financial and episode / encounter data Tools (Reporting) analysis; post-event clinical analysis; clinical or financialanalytics/metrics • ONC 2011/2012 CMS EHR Meaningful UseACO Beneficiaries Stage 1 Certified EHR Technology
  21. 21. Intermediate
  22. 22. Successful HIT Intermediate Requirement Milestone Technology Required Provider Network ACO Risk and Management and • Case Management Revenue Contracting; Bundled- Tools Payment Administration; • AR Systems Management Payment Allocation • Patient Portals and Pro-active care Secure Email management; Social • Patient survey toolsACO Beneficiaries Networking (provider to • Possible social patient); Evidence-based networking (E.g., Protocols Forums, Blogs, etc.)
  23. 23. Successful HIT Intermediate Requirement Milestone Technology Required • Case Management Tools ACO Care Coordination of Care • Population through HIE; Patient- Management Tools Management Centered Medical Home • Digital DashboardsAcross Continuum Anchor • HIE • Lab Interfaces • Data Repository Production HIE using CCD, Clinical ingest only; Dynamic • Limited HIE Information Information; Push of • Patient Portals Information to Patient Exchange Portals
  24. 24. Successful HIT Intermediate Requirement Milestone Technology Required Data-mining, • Dashboard analytics and metrics modeling with Population Management; • Care Site-Specific Continuum data financial and aggregation; Predictive Analytics • Business Intelligence clinical analysis and modeling Toolsanalytics/metrics • Data Repository • ONC 2013/2014 Certified EHR (Stage 2 MU) CMS EHR Meaningful UseACO Beneficiaries Stages 2 and 3 • ONC 2015 Certified EHR (Stage 3 MU) • EHR-based PQRS (GPRO)
  25. 25. Mature
  26. 26. Successful HIT Mature Requirement Milestone Technology Required • Member Network Management Systems • Provider Network ACO Risk and Management Systems Revenue Full Risk Management • Prospective and Retrospective Payment Management Systems • Utilization Trending and Reporting • Patient Portal • PHR Preventive and Chronic • Patient Survey Tools Disease Management;ACO Beneficiaries Lifestyle Intervention / • Remote Monitoring and Self-Management Consultation Tools • Social Media, at large
  27. 27. Successful HIT Mature Requirement Milestone Technology Required • Case Management Established evidence-based Tools ACO Care disease management and • Population wellness protocols; Patient Management Tools Management Health Maintenance • Digital DashboardsAcross Continuum Compliance; Provider • Advanced HIE Referral Management • Lab Interfaces • Data Repository Clinical Fully digestible, real-time • Full, Bidirectional HIE Information production HIE across full • Patient Portals continuum; Full Patient PHR • PHR Exchange
  28. 28. Successful HIT Mature Requirement Milestone Technology Required Data-mining, Real-time Population • ACO-wide Digital Management using modeling with aggregated data across Dashboard analytics and metrics financial and continuum of care; Provider • Business Intelligence and Patient analysis; clinical Dashboard analytics and Toolsanalytics/metrics • Data Repository metrics across continuum • ONC Certified EHR Market-specific, network Technology and provider Clinical • EHR-based PQRS Quality Measures (CQMs); (GPRO)ACO Beneficiaries Behavioral Economics and • Evidence-based Analysis; EHR-based Clinical Decision Reporting Support Repository and Tools
  29. 29. SuccessEHS &ACOs
  30. 30. SuccessEHS ACOStandards include• Prospective / Retrospective Payment Systems• Utilization Trending and Reporting• Evidence-Based Clinical Decision Support• Patient Survey / Questionnaire Tools
  31. 31. SuccessEHS ACOStandards include• Population Management Technology• Digital Dashboards• HIE in compliance with IHE Standards• Patient Education• Lab, Radiology and Device Integration
  32. 32. SuccessEHS ACOStandards include• Public Health related Integration (E.g., State Labs, Immunizations Registry)• PCMH Relevant Technology and Toolkit – BIG• Datacenter – BIG• EHR-Based PQRS Reporting - BIG
  33. 33. For more information aboutindustry trends, forwhite papers, articles, blogposts and more! Click here for our industry blog