Last week, the Department of Health & Human Services released its 429-page proposed rule for accountable care organizations (ACOs). The proposed rule includes a number of references to the meaningful use of electronic health records (EHRs). But early critics say there’s a pretty big gap between the meaningful use criteria and the proposed requirements a health care organization has to meet to become an ACO.
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Meeting the meaningful use criteria looks like a cakewalk compared to meeting the proposed ACO rules, says John Moore at Chilmark Research. He also emphasizes that before any health care organization can become an ACO, it must have a robust health IT infrastructure in place.
A recently published report, co-sponsored by the Patient Centered Primary Care Collaborative (PCPCC), also positions health information technology as one of “[f]our value-driving elements that are central to the advance of health care transformation.” The report, titled Better to Best: Value-Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations, is a summary of recent presentations and discussions among high-level health care stakeholders about the emerging models of care delivery known as the patient centered medical home (PCMH) and the accountable care organization.
There are two major challenges facing health IT’s ability to support the PCMH and the ACO, says Dr. David Nace, vice president and medical director at McKesson Corp., member of the PCPCC board of directors, and co-author of the report’s chapter on health IT. Those challenges are:
- The technology just isn’t there: Critical gaps still exist in the market for health IT.
- The HITECH Act’s meaningful use criteria are not aligned with ACO requirements.
Health IT is not a transformer of health care, Nace says, but simply an enabler of access, care coordination and payment reform. “Health IT must drive and support workflow, process and relationship changes; those changes will support the meaningful and necessary changes to practices and systems,” he says.
There are significant gaps in the meaningful use criteria that must be addressed before health IT can truly enable care transformation, Nace says, noting in particular that “the core principle of comprehensive, team-based and collaborative care among staff within a practice is not explicitly covered by the currently established meaningful use concept.” To that end, he recommends that a detailed gap analysis should be performed to examine the differences between current and proposed meaningful use criteria and the functional health IT requirements for the PCMH. He also recommends that accreditation organizations align their PCMH and ACO standards with the HITECH Act’s meaningful use criteria.
Health care organizations looking to “mind the gap” between meaningful use criteria and ACO requirements had better get a good running start.