As accountable care organizations (ACOs) spring up, more institutions will be communicating with each other to deliver and be reimbursed for care that is judged by its quality. This will be a challenge, as multiple hospitals and practices team up with and talk with myriad payers. Leveraging health IT to streamline and improve those communications will not only make it easier for all involved, but could be a crucial element to staying afloat and delivering the best possible levels of care.
Steve Bethke, vice president of product management at Lumeris, an ACO that helps EHR vendors and insurance companies develop solutions for their industry, cited five areas in which health IT will help ACOs keep pace with new and emerging demands.
Improving provider-payer dialogue. The healthcare paradigm is shifting to a mode where the overall health of a patient is the cash cow, not episodic expensive treatments. In this light, "the provider is now invested in the health of the population," said Bethke. Healthcare IT solutions such as analytics and EHR integration between the payer and the provider can improve communication, and drive results focused on the end goal of improving patient outcomes. Bethke noted that IT solutions can be deployed to answer the question "how am I doing on my quality measures today?" and that the "system can help expose gaps in care…[by] utilizing the data that's available and has been aggregated from the ecosystem."
Going beyond clinical settings. Taking medicine to the people and trying to foster a higher level of patient-physician engagement is one of the golden ideals an ACO hopes to achieve. Better connected patients do more to drive their own care, resulting in a healthier patient population and a higher level of compensation for the organization. "Today we see one huge benefit in healthcare IT [in] empowering the physician with the right information and the right sort of compensation structures to engage patients in meaningful ways," said Bethke. He also referenced the use of IT to help simplify everything from exposing high-risk patients to improving scheduling.
Identifying new best practices. Newly formed ACOs will, like every other new entity, feel some growing pains. Taking advantage of the introspective powers that health IT can provide, Bethke said it is possible to learn from mistakes and over time identify new best practices for how to operate. "Now that you have this information exposed to the right people at relevant times, people are always being exposed to new ideas," Bethke added. "Once you get the information, you can iterate, you can understand, you can test," new best practices. He warned against taking the nail-looking-for-a-hammer approach, though: "We haven't said let's take a cool technology and see what we can do with it." Instead, he said a better approach is to look at how an ACO operates, identify what could be changed, and then bring in analytics.
Improving payment. Payment models are shifting from the old fee-for-service model to a new standard that reimburses based on the overall quality of care. In a world where "a lot of fee-for-service claims go away," according to Bethke, new IT tools are crucial for an ACO. "It doesn't matter if you did six MRIs for [a patient], because you get a dollar to care for this patient and you've got to work through that dollar," he said. While the money per patient isn't literally a dollar, the example serves to show that an ACO manages a population's health like it would any other investment, and that leveraging technology helps ACOs find underserved patients, people who aren't correctly being treated, and other misses. "We identify some of those via risk adjustment capabilities," added Bethke.
Enhancing communications. ACOs are big. Keeping all of their players on the same page, while trying to achieve the first four things outlined above, calls for new technology and a rethinking of the way information is exchanged in the healthcare world. More specialists and practitioners will be talking and sharing information with one another more of the time -- and this calls for some rethinking of how that talking and information sharing will be done. Bethke referred to health IT as the tool that makes sure people "see relevant information and are connected to relevant people." He said that role-based security (which restricts access to a patient's information based on the role of a user) paired with cloud communications have the potential to make communication simple across ACOs. "If you're a physician in Hospital #1," and information is "all on the cloud, you log in and see the care plan that's put together by the care manager in Hospital B." Bethke noted that cloud sharing enables practitioners to "see the relevant data coming from a wide range of payers, providers,and organizations."