Posted by: RedaChouffani
Accountable care organizations, ACO, Health information exchange, HIE
As 2012 approaches and CMS kicks off the official start for Accountable Care Organizations (ACO), we are reminded of the changes that participating physicians in an ACO will face. Below is a list of 6 considerations that need to be on their agendas in 2012.
Defining the ACO structure: As an organization, the ACO is comprised of health care professionals coming from a range of entities (hospitals, independent physician groups, physician’s associations), and defining the ACO structure will be the first step to be addressed. As part of this consideration, an organizational structure must be defined, with steering committees over all stakeholders or entities.
Performance measurements and reporting: While the final ruling requires only 50% of the participants to have electronic health records (EHRs), outcomes measurement and reporting would be a key performance indicator for the ACO. This would require the ACO to set up an environment, processes, and workflows that will allow the capture of all required electronic information that will be utilized for reporting purposes, including information from non-EHR users.
Legal framework: In the final rule released on Oct. 20, 2011, CMS issued an interim final fraud and abuse waiver rule. This was intended to remove the existing legal impediments in the areas of fraud and abuse. FTC/DOJ did issue an antitrust guidance and clarifications for ACOs as well. The ACO organization must also ensure that it defines all its legal clarifications with its members as well as patients.
Technology considerations: As many of the health information exchange (HIEs) become increasingly available in new states and communities, they will serve as the vehicle that will allow many of the ACOs to achieve true health information exchange among its members. However, almost all ACOs will be required to invest capital toward an infrastructure that will enable: Data collection, collaboration tools, business intelligence platforms for reporting, hardware, connectivity and a technical support team that will oversee the ACO infrastructure.
Financial modeling: An ACO is intended to help health care physicians work as a group to improve patient care and reduce health care costs. But an ACO will need to first define the business model in order to be a successful and sustainable for collaborative work. This would require the definition upfront of how shared savings are literally shared amongst different participating members as well as how expenses are shared.
Care delivery: ACO members will become responsible for the complete care of patients. This will require health professionals to be in more contact with their patients and use effective ways to do so. Whether it is by using patient health monitoring devices or evisits to follow up with a patient who is at home, physicians will need to adapt to using these effective methods to communicate and be in touch with their patients.