Advanced Health IT Needed For ACO InitiativesAdvanced Health IT Needed For ACO Initiatives

Health IT Boosts Patient Care, Safety

As the drive to design a workable accountable care organization model gets under way, the Centers for Medicare and Medicaid Services announced several Affordable Care Act initiatives that require a robust health IT infrastructure to support doctors, hospitals, and other healthcare providers in improving care with Medicare through ACOs. The new ACO models could save Medicare up to $430 million, CMS said.

Among the initiatives introduced is the Pioneer ACO Model, an ACO model that will be available to providers this summer and is designed for advanced organizations ready to participate in shared savings. The Center for Medicare and Medicaid Innovation will support this model, CMS said.

The Innovation Center released a request for applications last week for the Pioneer ACO Model, which provides a faster path for mature ACOs that have already begun coordinating care for patients and are ready to move forward.

This model is designed to work in coordination with private payers to achieve cost savings and improve quality across the ACO, thus improving health outcomes and reducing costs for Medicare beneficiaries as well as employers and other insurers. The CMS Office of the Actuary estimates that the care models developed through the Pioneer ACO Model could save Medicare up to $430 million over three years.

ACOs have come under fire recently, particularly from the American Medical Group Association, which sent a letter to CMS Administrator Donald Berwick informing him that in a survey of its members 93% said they would not enroll as an ACO under the current regulatory framework.

The letter also described the current proposed rules for ACOs as "overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive."

"A lot of the ACO pilot programs have had questionable savings, their startup costs are very high, and it seems to take several years for organizations to realize savings from that model," Judy Hanover, research director at IDC Health Insights, said in an interview.

In the second initiative, CMS announced that the Innovation Center is seeking comment on the idea of an Advance Payment ACO Model that would provide additional up-front funding to providers to support the formation of new ACOs. The Advance Payment ACO Model would give certain ACOs participating in the Medicare Shared Savings Program access to their shared savings up front, thereby helping them make the infrastructure and staff investments crucial to successfully coordinating and improving care for patients.

"I think the Advance Payment ACO Model is about managing the initial startup costs as a way to get ACOs up and running as a viable entity," Hanover said.

These new models require a comprehensive array of health information technology to create efficiencies in the system that will help CMS realize its goal of bending the cost curve, Hanover, said.

Key technologies will enable an ACO to deliver on its promise of providing efficient care that contains costs, Hanover said. These include the following:

-- Clinical applications such as electronic health records and computerized physician order-entry systems. These are essential to collecting the data that providers will need to measure and start to affect the performance of the ACO. These systems must adhere to meaningful-use requirements.

-- Clinical decision support systems. These allow providers to implement interventions at the point of care. By identifying those interventions, providers can improve care coordination, care quality, and outcomes for patients, which will lower costs.

-- Data analytics tools. These tools allow providers to analyze clinical, administrative, and financial data to help ACOs better manage their operations in order to optimize and begin to perform and profit as an organization.

-- Care management applications. The function of an ACO is to coordinate care; to engage members in their care; and to help to coordinate the service providers, the members, and the payers in order to deliver the best outcome to patients and help with compliance.

-- Data center technologies that help to cut costs. These include virtualization and service-based technologies for storage and server management.

-- Revenue cycle management technology. This prepares ACOs for ICD-10 and 5010 HIPAA electronic transaction requirements as well as future revenue cycle challenges associated with accepting, negotiating, and managing a bundle payment structure.

"Over and over again, we have seen that improving how care is delivered to patients is key to reducing the growth in health care spending," Berwick said in a statement. "When we improve the coordination of care between providers, reduce duplication of services, and avoid medical errors, we can get better outcomes for patients at less cost. The Affordable Care Act has given us the tools to achieve these goals."

The Innovation Center's third initiative will be to offer new, free Accelerated Development Learning Sessions to teach providers interested in becoming ACOs what steps they can take to improve care delivery and how to develop an action plan for moving toward providing better coordinated care. Four Accelerated Development Learning Sessions will be held this year, with the first session is scheduled for June 20-22 in Minneapolis.

These initiatives complement the Medicare Shared Savings Program by providing additional options for ACOs. CMS issued a proposed rule to implement the Medicare Shared Savings Program in March and is continuing to encourage and accept comments from providers and the public that will help strengthen the final rule.

Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 10,. Applications must be received on or before July 18. The Innovation Center will accept comments on the Advance Payment ACO Model, if submitted prior to June 17. Comments should be submitted via email to [email protected].

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