Tuesday, December 24, 2013

Accountable Care Organizations and Health Information Exchange

No surprise here.  Accountable Care Organizations are going to require massive amounts of data sharing between the hospital, it's medical staff either as a whole or by  specialty.

Electronic health records and health information exchanges are an early beginning to having meaningful data, although the true nature and scope of HIE is limited by the fields that are interoperable and visible to users. Many health information exchanges only allow sharing of limited data....ie diagnosis, medications, and perhaps a discharge summary.  That in itself would be a helpful and very useful study.

Accountable Care Organizations will be searching for information systems to accomodate the needs of an ACO.

Hospital EMR & EHR reports

With accountable care becoming the standard for providers, more and more are seeking out best-of-breed vendors that can fill in the gaps in their health IT lineup and meet expected ACO requirements. It seems that just having it EMR in place doesn’t do the trick by itself. 

Management of an ACO is an entirely new industry, one that is very immature and the availabliity of experienced ACO  CEOs is very limited.  I am not sure what 'best of breed vendors means in such an immature market, nor how to compare or rate vendors.  This sounds much like a repeat of EHR software or Health Information Exchange offerings.

KLAS, a large consulting firm describes its mission, helping healthcare providers make informed technology decisions by reporting accurate, honest, and impartial vendor performance data.  The Best in KLAS Awards for Medical Equipment report is published June 15 and the Best in KLAS Awards for Software and Professional Services report is published December 15. 

 KLAS spoke with 73 organizations – mostly medium- to large-sized IDNs and hospitals –  to gauge where they are in their migration from volume to value and accountable care. The goal is to eliminate reimbursing for procedures to eliminate or minimize the 'do more' to gain  income mindset that has been embedded in the economics of medical reimbursement.

That's the conclusion from the newest KLAS report, "Accountable Care Timing 2013: Migration from Volume to Value Speeds Up," which shows that more than 65 percent of providers interviewed are looking to niche vendors to address the critical areas of population health, health information exchange and business intelligence.

We’ve known all along that the ACO game was going to be an expensive one. If KLAS is right, it’s going to be a whole new independent marketplace, in which providers shop for calls that fill in huge gaps in their existing ACO toolkit. If I were CIO, however, I’d be pretty annoyed that the huge investment made situation made in an EMR can’t get the job done all by itself.
Now the question is which health IT areas hospitals and medical practices will take on first; after all, there’s lots of ways to attack the question of how to prepare for the new, bold ACO world. My guess is that tools supporting population health measures will be particularly popular, as population health management is a key capability ACOs bring to the table that health systems alone may not.
The end game is complex, how to extract the data for analysis and merge it with population health measures, comparing expense with outcomes and maximizing better outcomes while holding expense flat, or decreasing it.
Some early ACO organizations are claiming some success in managing this goal, and it would be useful to survey what vendors and/or software combinations they use. Is it done in real time, or does it require separate data entry? 
The other big question is much like the analysis of ROI for EHR and HIX.  If the ACO will require new software, it will certainly be very expensive and no one can tell for certain what the ROI will be.
Several hospitals and INDs have lost considerable sums adopting well known EHR systems such as EPIC and/or Cerner. The failure of a central software infrastructure would be a fatal blow to a young ACO.  One that would rival the near catastrophic rollout of the national health benefit exchange in October 2013.
"This is a major shift from what we are seeing in most healthcare IT areas," said report author Mark Allphin. "What we are seeing in many areas is a migration toward integration. The fact that providers tell us that they will be looking to niche vendors over their EMRs tells us that the ACO market very likely is still up for grabs.”
So, this post raises more questions rather than answers. , 
Those early IDNs and early Pioneer ACOs may be ahead in discovering the answers to our questions.

Becker's Hospital Review lists 100 early ACOs, and CMS listed  32 initially, now down to 20 due to ACO dropouts.

Much of this information is open to question, a term which I call  "Truthiness'. CMS is claiming how successful their model is working.

According to CMS Nine of the 32 Pioneer ACOs are leaving the program, but the majority will continue. It is not surprising that some health care systems would re-evaluate their participation and choose to move on. The program does not guarantee that it will be the right fit for every health system. That’s the nature of innovation. And no model may be right for every population in every community.  It is important, however, to examine these departures for the lessons they offer.

Further commentary from CMS:

"We remain optimistic. ACOs represent one innovative model with the potential to improve care coordination, ideally leading to improved quality and lower costs. Testing of that model should continue, and we are pleased that the Medicare ACO program has given a boost to the development of ACOs, which are now proliferating among private health plans and provider groups"

Is this the message of idealogues, who will forge forward no matter the variability of success or failure.

We have seen the early missteps of Health Benefit Exchanges and there should be no reason to trust  CMS plans and/or statements.

Digital Health Space will be watching this niche carefully.

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