Download - Health IT and ACOs
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Health IT & ACOsAdele Allison,National Director of Government Affairs, SuccessEHS
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Health IT is the ACO Backbone. It will create Winners and Losers.
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Certified EHR Adoption is weighted twice as much as other performance measures.
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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
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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
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ACO Tools of the Trade• Patient Survey Tools• ACO-wide and Clinic-wide Digital
Dashboards• Business Intelligence Tools• Data Repository• Patient Population Management
Systems
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ACO Tools of the Trade• EHR-based PQRS (GPRO)• Advanced HIE
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ACO Blueprint
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Patient EngagementStrategies
Care Coordination
Data and Reporting
Continuumof Health Care
“In-Network” Referrals
PCPs and SCPs
Physician-Driven Operations
ACO Leadership
ACO Internal and External Governance
Hea
lth IT
Patient-Centered
Care Using PCMH
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Long-Term ACO Decision Points
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Extend Valuecreated to other Payers/Employers
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Systems and Processes must consider:• Participant Performance Metrics• Operations/Data Exchange• Medical Management (E.g., Case
Management and Utilization Review)• Provider Contracting
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Systems and Processes must consider:• Product Development/Benefit Design• Marketing and Communications
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Requires clearly identified Champion (E.g., CMO)
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Requires Community-Wide “Buy-in”
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Health IT & ACO - Maturity
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Beginner
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Successful HIT Requirement
BeginnerMilestone Technology Required
ACO Risk and Revenue
Management
Care Continuum Cost Accounting for Target Clinical Events and/or
Chronic Conditions
• Membership Information Tools• AR Systems
ACO Beneficiaries
Patient Engagement; Episode of Care
Management; ACO Patient Support; "In-Network"
Referral Guidance
• Patient Portals• Patient-Specific Education Tools • Referral Management System
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Successful HIT Requirement
BeginnerMilestone Technology Required
ACO Care Management
Across Continuum
Provider Network Development; Case
Management; Protocol Compliance Tracking and
Provider Utilization Reporting
• Case Management Tools• Population Management Tools• Digital Dashboards
Clinical Information
Exchange
Read-only access based on user request (E.g., fax);
Static Information
• e-Fax• Secure Email
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Successful HIT Requirement
BeginnerMilestone Technology Required
Data-mining, modeling with financial and
clinical analytics/metrics
Non-aggregated and single-patient focused;
episode / encounter data analysis; post-event
analysis; clinical or financial
• Business Intelligence Tools (Reporting)
ACO Beneficiaries CMS EHR Meaningful Use Stage 1
• ONC 2011/2012 Certified EHR Technology
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Intermediate
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Successful HIT Requirement
IntermediateMilestone Technology Required
ACO Risk and Revenue
Management
Provider Network Management and
Contracting; Bundled-Payment Administration;
Payment Allocation
• Case Management Tools• AR Systems
ACO Beneficiaries
Pro-active care management; Social
Networking (provider to patient); Evidence-based
Protocols
• Patient Portals and Secure Email• Patient survey tools• Possible social networking (E.g., Forums, Blogs, etc.)
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Successful HIT Requirement
IntermediateMilestone Technology Required
ACO Care Management
Across Continuum
Coordination of Care through HIE; Patient-
Centered Medical Home Anchor
• Case Management Tools• Population Management Tools• Digital Dashboards• HIE• Lab Interfaces• Data Repository
Clinical Information
Exchange
Production HIE using CCD, ingest only; Dynamic Information; Push of
Information to Patient Portals
• Limited HIE• Patient Portals
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Successful HIT Requirement
IntermediateMilestone Technology Required
Data-mining, modeling with financial and
clinical analytics/metrics
Population Management; Continuum data
aggregation; Predictive analysis and modeling
• Dashboard analytics and metrics• Care Site-Specific Analytics• Business Intelligence Tools• Data Repository
ACO Beneficiaries CMS EHR Meaningful Use Stages 2 and 3
• ONC 2013/2014 Certified EHR (Stage 2 MU)• ONC 2015 Certified EHR (Stage 3 MU)• EHR-based PQRS (GPRO)
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Mature
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Successful HIT Requirement
MatureMilestone Technology Required
ACO Risk and Revenue
ManagementFull Risk Management
• Member Network Management Systems• Provider Network Management Systems• Prospective and Retrospective Payment Systems• Utilization Trending and Reporting
ACO BeneficiariesPreventive and Chronic Disease Management; Lifestyle Intervention /
Consultation
• Patient Portal• PHR• Patient Survey Tools• Remote Monitoring and Self-Management Tools • Social Media, at large
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Successful HIT Requirement
MatureMilestone Technology Required
ACO Care Management
Across Continuum
Established evidence-based disease management and wellness protocols; Patient
Health Maintenance Compliance; Provider Referral Management
• Case Management Tools• Population Management Tools• Digital Dashboards• Advanced HIE• Lab Interfaces• Data Repository
Clinical Information
Exchange
Fully digestible, real-time production HIE across full
continuum; Full Patient PHR
• Full, Bidirectional HIE• Patient Portals• PHR
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Successful HIT Requirement
MatureMilestone Technology Required
Data-mining, modeling with financial and
clinical analytics/metrics
Real-time Population Management using
aggregated data across continuum of care; Provider
and Patient analysis; Dashboard analytics and metrics across continuum
• ACO-wide Digital Dashboard analytics and metrics• Business Intelligence Tools• Data Repository
ACO Beneficiaries
Market-specific, network and provider Clinical
Quality Measures (CQMs); Behavioral Economics and
Analysis; EHR-based Reporting
• ONC Certified EHR Technology• EHR-based PQRS (GPRO)• Evidence-based Clinical Decision Support Repository and Tools
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SuccessEHS & ACOs
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SuccessEHS ACO Standards include• Prospective / Retrospective Payment
Systems• Utilization Trending and Reporting• Evidence-Based Clinical Decision
Support• Patient Survey / Questionnaire Tools
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SuccessEHS ACO Standards include• Population Management Technology• Digital Dashboards• HIE in compliance with IHE Standards• Patient Education• Lab, Radiology and Device Integration
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SuccessEHS ACO Standards include• Public Health related Integration
(E.g., State Labs, Immunizations Registry)
• PCMH Relevant Technology and Toolkit – BIG
• Datacenter – BIG• EHR-Based PQRS Reporting - BIG
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