I will not pretend to know more about Accountable Care Organizations (ACOs) than Dr. Elliot Fisher of Dartmouth Medical School who is the unofficial founder of the ideas behind this new model for healthcare reform. But if I may, I’d like to leverage some of his ideas to outline the necessary first step for creating a new ACO or being included in one of the many that already exist.
First and foremost, I understand that there are very smart people out there who insist ACOs are a bad idea (click here and here to read strong arguments against ACOs). Having said that, there are fundamental aspects of ACOs that are prerequisites for success; one of these is the ability to calculate mandated performance metrics and share this data electronically with other members of the ACO. How else are they going to know if it’s working (and by working I mean lowering costs while improving the quality of care)?
Healthcare providers are used to having to calculate quality metrics, like Core Measures amongst others, for the purposes of demonstrating high quality care, being compliant with regulator mandates, and satisfying their patient populations. What they’re not used to is having to report in a timely fashion. Hospitals routinely, for instance, report CMS core measures months after the patient encounters actually occurred. The previous 3 clients I worked with reported March/April/May measures in August. The Senate Bill that allows for CMS to contract with ACOs specifies the need to share performance metrics among participating entities but leaves the how and how often to each ACO to decide. This could be extremely problematic considering the huge discrepancy across our provider networks of the necessary healthcare IT infrastructure to gather, calculate, and report these metrics across care settings in a timely manner.
The first thing to consider when contemplating participation in an ACO is, “How robust is your data infrastructure and can you meet the reporting requirements mandated for any ACO participation?” Dr. Fisher points out, “We have been collaborating withCMS, private health plans, and medical systems to identify and support the technical infrastructure needed to deliver timely, consistent performance information to ACOs and other providers.” If you think your paper-chasing and manual chart abstraction that gets you by today for most reporting requirements will fly, think again. An ACO will only be as strong as its weakest link. A successful ACO is able to monitor its progress against the benchmarks established for total cost for delivering healthcare services per enrollee. The overall goal is to lower the cost to provide services while maintaining a high level of quality, and subsequently share the cost savings. There are other similar models such as the Alternative Quality Contracts (AQCs) currently rolled out by BCBSMA, with similar criteria and financial incentives. In both cases, though, the fundamental data infrastructure is required to meet the stringent reporting requirements. In addition, as ACOs gain traction and identify new ways to lower the cost of providing care, the need for a robust reporting infrastructure to eliminate the tremendous amount of time and money spent on collecting, calculating, reporting and distributing information including quality, operational, clinical, and financial metrics becomes even more instrumental. The best case scenario also includes an evolution to healthcare analytics when analysis of data spans care settings, siloed applications, and even facilities (Chet Speed, the American Medical Group Associations VP, Public Policy agreed with me on this point in his recent interview with Healthcare Informatics). But first things first.
You can do a lot to improve your chances of success within an ACO; start with understanding the requirements for sharing discrete, accurate, consistent data, it’s a great first step. Good luck!