ACO member engagement
The underpinnings for ACOs will be a patient-centered system of healthcare, in some cases organized around primary care-based medical homes; in others organized around health maintenance and clinical care processes; in others around specialty medical homes optimized for specific diseases.
The ACO member engagement objective for an ACO is to enable self-service for members to participate in their own care and to manage their administrative and financial interactions easily, efficiently and conveniently.
Patient portals that provide access to an underlying EHR, available online and via kiosks, give patients access to clinical support, such as secure provider messaging, reminders, alerts, test results views and prescription refill requests. Personalized to the patient or member, the portal will also contain access to tailored health information and provide access to customized health maintenance modules for conditions such as smoking cessation, weight loss, depression and nutrition. Portals will also enable ACO members to connect remote physiologic monitoring devices such as blood pressure cuffs, scales, heart monitors and other remote devices for transmission of real-time data to tracking systems utilized by their care providers.
Clinician contact center support—that integrates real-time chat—also has proven to be of significant value in serving patients more effectively. Portal functionality must also support administrative and financial tasks including access to registration, appointment scheduling, messaging and other systems that make it easier for members to access (and therefore enhance relationships with) providers in the ACO network. Social media applications include patient-to-physician secure messaging (including instant), use of Twitter and social networks to support adherence to health regimens, physician profiles and blogs similar to Facebook pages, and user-generated content that will range broadly from provider evaluations to reports on treatment.
Cross continuum medical management
The HIT starting point for supporting cross continuum medical management is the patient electronic health record that can be partially or completely transferred or shared between and among referring and receiving providers. An enterprise EHR is a fully integrated system that gives each user (at the hospital, practice, and other ACO sites) an opportunity for customized views and templates for entering and retrieving patient clinical data and information. It uses a common patient database that gives each user real-time access to all relevant patient information available within the ACO, based on their assigned privileges, security access and "need to know."