Healthcare’s shift away from traditional fee-for-service reimbursement models and toward value-based payments is well under way. Case in point: The Centers for Medicare & Medicaid Services (CMS) recently announced that 106 new accountable care organizations (ACOs) have begun operations, bringing the total number of Medicare Shared Savings Program participants to more than 250. ACO growth has also gained a foothold in the private sector, with 428 organizations now operating in 49 states.
The existence of the ACO stems from a mandate put forth in the Patient Protection and Affordable Care Act of 2010. Unlike other care delivery models, it aspires to achieve healthcare’s triple aim — improving individual patient care, enhancing population health and reducing care costs — by tying provider reimbursement to quality and financial metrics. This distinction is significant, because it requires ACOs to have technologies capable of supporting a new and more highly coordinated care delivery model.
Imaging and the ACO
An ACO typically encourages collaboration among providers from different parts of the continuum of care — including primary care, specialty practices, hospitals, pharmacies, and imaging and diagnostic centers — to deliver high-quality and lower cost patient care. Imaging technology can be used to directly support all of these objectives as well as enhance patient engagement.
Some healthcare organizations and physicians are now using cloud-based and Web-enabled devices, such as tablet computers, to securely access and manage patients’ medical images and radiology reports. In fact, one application simplifies image sharing among doctors across organizations, as well as between doctors and patients, bolstering care coordination initiatives for providers associated with ACOs. The platform sits on top of current imaging repositories such as picture archiving and communication systems (PACS), and makes images easily available to anyone authorized to view them — including the patient.
This approach supports accountable care in two ways. First, it virtually eliminates unnecessary and redundant images from being taken by other providers caring for the same patient, thereby helping to lower costs. Furthermore, patient safety and outcomes can be improved because triage times are faster and providers are able to make more informed decisions during critical episodes of care.
Because ACOs come in various shapes and sizes, a one-size-fits-all approach to technology will not yield a customized solution that conforms to the unique workflows of a specific ACO. Instead, some fundamental requirements and characteristics linked to the ACO business model will drive overall healthcare information technology (IT) innovation.
Current Technology: A Gap to Fill
ACOs have a basic set of technology needs that must be met if they are to succeed and thrive. These requirements generally center on the ability to enable real-time sharing of clinical and financial data among disparate systems, providers and organizations. Current health IT contributions offer a starting point and address some of these requisites to a degree. For instance, existing hospital information systems, electronic health records (EHRs) and health information exchanges (HIEs) possess some of the functionalities necessary to support governance, operations, and clinical goals and objectives.
Yet even with these systems, one critical unmet need still remains for the ACO: technology that seamlessly integrates across boundaries for care coordination, delivery, reporting and payment. Most current technology is designed to record patient care information during an episode of care — not over time — and is limited to each care setting’s organizational boundaries.
By contrast, the success of the ACO model hinges on the development of end-state technologies that support electronic exchange of clinical information, longitudinal care records, care coordination (especially between acute and ambulatory environments), reports for payment distribution and data collection for measuring progress against goals.
Toward this end, the coherent integration of technology is necessary to sustain the mission-critical competencies associated with the ACO model, including:
• Care coordination. Facilitated by EHR, HIE and provider messaging systems, a cross-organizational care management workflow will require clinical decision support tools at the point of care, as well as shared care plans and the ability to track referrals.
• Population health management. Tools to support health risk assessment and clinical decisions will need to be joined by registries, workflow management solutions, and tools to aid in predictive modeling and analytics.
• Patient engagement. To encourage patients to actively participate in their healthcare decisions, ACOs must rely on telehealth and mobile health applications, as well as patient portals, patient health records and survey tools.
• Quality performance. Dashboards and business analytics software will be essential for tracking and reporting patient outcomes.
• Risk management. Administrative solutions
that enable complex case management, risk
modeling and benchmarking will be necessary to control financial risk.
The core infrastructure of all these systems must additionally reinforce semantic interoperability, controlled terminology, security, identity management and patient consent. However, cobbling together a health IT solution from a mixture of healthcare technology vendors will not necessarily ensure adoption by ACO providers and other end-users. Technology that has not been carefully built with the workflow needs of its end users in mind will likely be met with resistance.
Adoption Requires User Experience, Provider-Centered Design
Currently, healthcare technology seldom fully leverages usability and user experience methodologies. This “elephant in the room” has been the culprit behind poor technology adoption rates. Yet in order to thrive, ACOs must be able to deploy technology from day one that, based on the initiative’s unique workflow and end-user needs, will support care coordination and patient engagement. With the advent of ACOs, the time has come to incorporate user experience and provider-centered design into applications in order to strengthen their adoption.
There is universal agreement that ACOs will require workflow modifications. Appropriate user research, interface design and usability testing will be essential for ensuring software meets the needs of the ACO delivery model, while complying with regulations and ensuring quality care and patient safety. Add to these demands the need for improved patient engagement, and suddenly it becomes clear that ACOs offer a reality in which technology innovation can flourish.
The concept of incorporating high-quality user experience and intuitive, provider-centered design already is starting to take hold among innovators in the areas of care coordination and population health management. For example, one company is making the delivery of safe care at home possible by using EHR technology for individuals who have been hospitalized. Another company is advancing providers’ ability to perform population health assessments and stratifications through the development of care management software solutions.
ACOs Will Live (or Die) by Their Technology
Over the past 15 years, healthcare has invested enormous sums of capital into IT infrastructure and systems. The lion’s share of that investment has gone to support the status quo until just recently, but now the landscape is changing. ACOs are dictating enormous change in care delivery and advancement in technology.
Current health IT solutions do not entirely meet the unique needs of the accountable care model, and must be reinvented accordingly. It will be fascinating to see how this market shifts in scope, size and character over the next few years.
At the end of the day, greater technology innovation will be required to ensure the sustainability of the ACO model. For ACOs to find a permanent and welcome place in the U.S. healthcare system, pioneering technologies must be deployed that enable these organizations to focus on enhancing patient care quality and lowering financial risk. Such an IT strategy will pay dividends not only for ACOs, but for patients as well, as it starts to solve the perpetual riddle of how to contain costs and remain fiscally viable while delivering coordinated, high-quality healthcare.
David Karabinos is president and CEO of PointClear Solutions, a software development partner that incorporates expertise in clinical informatics and user experience to build transformative healthcare technologies. Karabinos has more than 30 years of experience as an executive in the technology and business services industries.