Traditional cost accounting and patient accounting systems and processes must be assessed, and likely expanded as well. ACOs must provide a complete spectrum of services in a variety of health care settings, any or all of which will present new accounting and billing requirements and capability. Provider network management and contract management will determine ACO investment in applications and processes that will allow them to manage and distribute ACO revenues to all the participants in care delivery and patient service. The specific application requirements will vary based on employment and contracting models among the entities that combine to form the ACO, but it is likely that large-scale ACO organizations will require the ability to administer and process claims for healthcare services—perhaps in order to pay providers, but certainly in order to measure and monitor provider productivity and population utilization of services.
HIT investments to achieve ACO status will go well beyond those required to address other current HIT trends, such as meeting EHR meaningful use criteria, converting to ICD-10 coding standards, and evolving pay-for-performance and value-based purchasing initiatives. As a result, organizations aspiring to ACO implementation need to carefully consider how they allocate spending for HIT along with other demands over the next decade.
The diversity of applications and tool sets increasingly available present a dizzying array to the CIO and the ACO clinical and administrative teams. A sourcing strategy will be required which can specify when to rent, outsource, build, buy or partner with other organizations to realize HIT solutions. At times, knowing when to wait for the market to catch up with affordable technology and/or service solutions will be the best approach while at other times, getting out in front will present clear advantages.
For all these reasons, organizations planning to implement and operate an ACO need an overall HIT roadmap that links capability development with the maturation and evolution of their ACO. That roadmap needs to include individual system and application tactics and strategies that fit into a long-term agenda for sequencing and implementing them tied to the ACO's growth in responsibility for managing patient populations.
Tom Enders is Managing Director at CSC's Healthcare Group,and may be reached at tenders@CSC.com. Jordan Battani and Walt Zywiak are Principal Researchers at CSC's Emerging Practices, the applied research arm of CSC's Healthcare Group.