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Meaningful Health Care Informatics Blog

Sep 25 2011   6:05PM GMT

Ambulatory practices preparing for ACOs and medical homes



Posted by: RedaChouffani
Accountable care organizations, ACO, ACOs, Care coordination, EHR adoption, Medical Home, private provider groups

For large ambulatory care providers, buying an electronic health record (EHR) is only one piece of the puzzle. This is especially the case when we look at how health care is transforming. Under many of the new mandates and reform efforts, we begin to recognize that many more components above and beyond a standard EHR will need to be in place to support an ACO, medical homes and other changes coming down the industry pike.

For some time now, there have been many pilots in place for ACOs and medical homes. Some have been able to offset the costs associated with the initial capital investment through CMS grants that have been available; others have established a community base ACO and leverage collective funding, which has allowed several private physician practices to create the infrastructure needed to collaborate on patient care.

As ACOs and medical homes grow in numbers, some of the larger, privately owned physician groups would need to define and prepare their infrastructure and ensure that their business model can adapt to the changing landscape.

Following are some of the changes that will affect the larger private health organizations:

The need for a community based HIE or Registry:

HIE is one of the core components that will be required in order to have a successful ACO or medical homes. This is the engine that will facilitate the exchange of patient health information. So for many organizations, having connectivity and the ability to exchange information is a must have. Unfortunately not all states will be able to provide an operational HIE when some practices will look to engage in ACO’s. This would leave many of the privately owned physician’s group looking to their local health system for similar infrastructure or create their own community based HIE. In Charlotte N.C. for example since there are two large health systems, one of which has taken the initial steps to implement an enterprise wide HIE and maybe on its way to enable future ambulatory practices to connect and exchange health records.

The need to create and fill more health IT (HIT) positions:

For sometime now, many of the mid to large physician owned groups have not required extensive health informatics knowledge as a perquisite for internal IT positions. As some begin to implement EHR and participate in ACOs and become medical homes, they are requiring additional staff with more healthcare specific training. Some of the skills needed in the candidate pool will be: healthcare data analysis, interface and integration experience, EHR experience, EDI, HL7, and an understanding of clinical and administrative workflow.

Establishing community-based collaboration that goes beyond care:

Since some of the reforms call for bundled payments for services and care, many of the physicians will need to work collectively at all different levels. When we discuss ACOs, we focus mostly on the collaborative efforts that physicians will be able to participate in when providing care for their patients. But there will also be additional collective work that will need to happen behind the scene to ensure payments are received, processed and distributed accordingly. CFO, coders, administrators and scheduling staff will need to work together to ensure that the practices are working toward the same goal and ensuring that they are collectively identifying process bottlenecks to better streamline the workflows.

Process reengineering:

For many practices that have continuously reevaluated their processes and improved on them, they will be challenged again to make further modifications. As with the shift toward preventative care, outcome based fee, bundled payment model, organizations will need to quickly adapt to the changes and rework their processes and workflows to ensure sustainability.

mhealth will play a bigger role:

As it stands today, smartphones and mobile devices are as far as IT is concerned are in the hands of very few clinicians. But as telehealth becomes more popular, health organizations will begin to use it to engage patients in their care as well as communicated with them. There are very few services that are covered under telehealth. But with the new ACO model and Medical home, providers now can be reimbursed for both virtual or home visits. In addition, many providers will need to monitor patients outside the practice settings and coach them. Mobile devices will then play a much greater role as they can provide the vehicle to transfer information regarding the patient to their health provider.

It is fair to assume that the only constant in health care is change. Whether it is through new mandates or simply moving toward a more sustainable health care system, many of the upcoming changes will require the organizations to reinvent themselves to navigate through the tough economy and ensure its success.

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