Monday, February 13, 2012

Will Accountable Care be the Final Straw for US Economy and Healthcare system?


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Few readers do not know about our present economic failures, and the prospect of inventing an unproven model to contain health costs could have the opposite intended effect, further increasing the %age of GDP devoted to US health care

Good afternoon readers. I tried to think of a short, catchy phrase for this subject, but failed miserably

For this post, however you will see with what I came up.

I have been pondering what a 'Project Manager' recruitment ad would read for establishing an Accountable Care Organization. I was about to construct my own plan and came upon this article from eHealthInitiative.

I found out very quickly what is involved.


Essential to the development of an ACO, small or large is Health Information Technology.

Key recommendations include:

  • a health IT infrastructure that is flexible to support the changing needs of an accountable care organizational model; (unknown at this time)

  • an infrastructure that supports the secure transfer, collection and storage of personal health data;

  • a patient-centered system to engage and educate patients and caregivers;

  • and a system that supports care coordination across the healthcare team and the patient.


"It may be difficult (read impossible) for accountable care organizations to accomplish all of their objectives without a strong technology base that facilitates care coordination and gives doctors the tools they need to provide quality and affordable care," said Jennifer Covich-Bordenick, eHealth Initiative's chief executive officer.

Accountable care is an issue of critical importance to physicians.................. With the right technology in place, these organizations have the potential to improve the health and well-being of their patient populations," said Michael S. Barr, MD, MBA, FACP, Senior Vice President, American College of Physicians.

The report was developed by a multi-stakeholder council which met over an eight month period, and involved the input of over 100 individuals and organizations across the healthcare industry. The council was co-chaired by Michael S. Barr, MD, MBA, FACP, Senior Vice President, American College of Physicians and Marcia Guida James, MS, MBA, CPC of Humana Inc.

The report can be downloaded on the eHealth Initiative Website at

Of some significance was that 50% of hospitals/groups are not interested in the ACO model.

eHealth Initiative 2011 Accountable Care Organizational Model Survey (ACOM)

The eHealth Initiative launched the Accountable Care Organizational Model Survey on October 7, 2011, and concluded the survey on November 29, 2011.

The survey of 20 regionally diverse groups revealed:

The majority of respondents were unsure or did not intend on applying for the Medicare Shared Savings Program or the CMS Innovation Center Pioneer ACO Model.

50% indicated that they did not intend on applying for the CMS MSSP program.

37.5% were unsure if their organizations intended on applying for the MSSP program.

12.5% stated that they intended on applying for the CMS MSSP program

ACOMS are utilizing a variety of payment models to achieve shared savings. Several organizations reported utilizing or planning to utilize a combination of models:

1. Twelve organizations reported utilizing or planning to utilize a FFS plus a shared savings payment model.

2. Eight organizations reported using an upside potential model.

3. Five models reported utilizing or plan to utilize a downside risk model.

4. Four organizations are utilizing or plan to utilize a bundled payment model.

Two organizations were utilizing a global risk model.

5. One model reported unsure.

I had not realized the ACO has the choice of a number of payment models and cost containment ranging from prepay HMO like contracts all the way to FFS with shared payment and cost containment measures

One of the key ingredients is the component of patient participation in health 2.0 which include:

Telehealth monitors.

Telephonic support.

Mobile technology.

Patient Portal.

Internet-based patient education programs.

Personal Health Comprehensive assessment tools to help providers determine the patient’s level of health literacy so that education can be tailored accordingly.

Online communications such as viewing a summarized patient record, enabling patient input, enrolling in health and wellness programs, linking to health information sites, managing permissions for record access.

I addressed these issues in my last article at HealthTrain Express “ Is The Patient Ready for Physician 2.0 ?

Whether it is a federally or provider-supported model, successful ACOMs will be judged on the basis of their ability to achieve progress in achieving the Triple Aim–improving the individual experience of care, improving the health of populations, and reducing the per- capita costs of care for populations

Key Attributes Needed for a Successful Health Information Technology Structure in the Accountable Care Organizational Model

Health information technology is essential to the success of the Accountable Care Organizational Model. The following list identifies key attributes needed for the development of a successful health IT infrastructure.

The health IT infrastructure must enable care coordination and collaboration.

The health IT infrastructure must enable and support the comprehensive and systematic collection, storage, management, and exchange of secure personal health information between and among healthcare providers, patients and other members of a patient’s healthcare team in the process of care delivery and care management.21

The health IT infrastructure must include revenue cycle management technology to successfully support the financial analyses associated with accepting, negotiating, and managing new and changing payment structures. The infrastructure should enable electronic acceptance, tracking and allocation of payments and should be able to handle the distribution of payments to individuals, practices, and other appropriate organizations within the ACOM based on performance associated with specific metrics of quality, cost and patient experience.22

Data exchanged by the health IT infrastructure should be maintained in a secure, HIPAA-compliant, online environment that allows role-based access to and sharing of data among and between stakeholders (including hospitals, physician practices, healthcare providers and payers).23

The health IT infrastructure should support the collection of information embedded in the workflow of healthcare delivery.

The health IT infrastructure should support the use of telehealth, remote patient monitoring, shared care plans, and other patient-centered enabling technologies between facilities, healthcare providers, and patients that securely exchange information.24

The information shared through the health IT infrastructure should be collected and stored in a manner that facilitates ongoing measurement of processes and outcomes related to quality, cost, and patient experiences at an individual and population level. The identified

The identified metrics will be important for the assessment of ACOMs.25

The health IT infrastructure should enable information to be transmitted, and accessible to all patients and healthcare providers authorized to view it.

The health IT infrastructure should integrate evidence-based clinical decision support system (CDSS) services into the workflow of care delivered by healthcare providers and their practices.26

The health IT infrastructure should support and facilitate shared decision-making and care plan development through the integration of information from all healthcare providers involved in the care of a patient. There should be convenient access to user-friendly personal health information organized to be meaningful for patients/caregivers and presented in a constant format across the organization.

The health IT infrastructure should support services for patients and caregivers to help them be informed, educated, and literate about personal health and medical conditions and to enable patient self-management of care.

The health IT infrastructure should offer support on-going self-care and wellness management functionalities including, but not limited to, coaching from healthcare providers and ongoing monitoring of progress to promote a dialogue between patients and healthcare providers.27

The health IT infrastructure should support the analysis of clinical, administrative, and financial data to support operations, improve care and better patient outcomes while optimizing the overall performance of the organization.28

To achieve the specific benefits health IT can bring to the ACOM; industry should focus on creating and implementing tools that address the key concepts. This report identifies three key concepts that the health IT infrastructure of the ACOM should support .

ehealthinitiative identified three main components that should be addressed by HIT

  1. Patient Safety

  2. At Risk Patient Populations

  3. Financial Accountability and Quality Management

The report can be downloaded on the eHealth Initiative Website at

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