As healthcare organizations begin to explore accountable care models, one thing is clear—technology will play a huge role. Organizations that are leading the way toward ACOs talked about how they'll use technology to reach their goals in the most recent HealthLeaders Media breakthroughs report, The Bridge to Accountable Care Organizations.
In a roundtable event that is part of the multi-media report, leaders talked about electronic medical records and health information exchanges—the foundation for identifying gaps in care and for housing data that will be used to guide physicians.
"Clearly, health IT is the backbone, the enabler to an ACO," says Warren Skea, PhD, director, health industries advisory practice at PricewaterhouseCoopers, which sponsored the report. "There won't be success unless information is free flowing between all entities. What we've heard is that it is critical to have one system within the organization.
Health information exchanges are critical but not every market has one, and I think that's going to be a significant hurdle for many markets. One of the challenges is that patients' cost and their care will be counted regardless of whether they receive in-network or out-of-network care. So if you've got patients who go outside the network to receive care, outside of your IT framework, it will be critical to get that out-of-network information as quickly as possible, making it interoperable and managing it in the most cost effective way and in the most timely manner."
"In a managed care system with referrals we know where the patient is headed before the cost is incurred and that gives our care management infrastructure a chance to help," says Nancy Boerner, chief medical officer at Monarch Healthcare, a 20-hospital system in Irving, CA. "In this system where choice will still be present, waiting for claims information—even if it's timely claims information—is a bit too late.
We're looking at an idea of having a care navigator that is an extension of the office practice to really be an adjunct to help the patient when something happens that we know could use some additional coordination because in this population that's really the challenge for us. Now we're trying to figure out how we can get involved with the information even before the claim hits."
Monarch CEO Bart Asner, MD, adds, "It's been an enormous amount of work to figure out who the patients are, get information and data on these patients, and figure out ways that will make the information flow smoothly through the system going forward."
In the ACO model, a variety of organizations must find ways to share information—that can be a challenge, says James Canedy, MD, a board member at the Nebraska Medical Center in Omaha, NE, which has partnered with the Methodist Health System to create an accountable care alliance. "We have a lot of different groups coming together: two health systems, an academic practice plan, independent physicians and health system employed population. And it's not hard to believe that they're all on different systems. So we are fortunate we have the Nebraska Health Information Exchange so we can pull data from any health system in the state. Most hospitals are enrolled in this, so we have access to data … but then how do you match that data with the other system data? So there are processes in place but it's a tough expensive, expensive model."
Getting the most out of an organization's information technology backbone is one of the crucial differences between now and previous efforts to manage population health, says Skea.
"Information technology and the willingness to share information among disparate groups will help to integrate care as well as support the ability to measure success and reach consensus on quality goals and metrics," he adds. "Early adopters are well on their way to positioning their organizations for an era of ACOs."
The Bridge to Accountable Care Organizations and other HealthLeaders Media Breakthroughs reports are available online.