health it and acos
Post on 09-Jun-2015
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Health IT & ACOsAdele Allison,National Director of Government Affairs, SuccessEHS
Health IT is the ACO Backbone. It will create Winners and Losers.
Certified EHR Adoption is weighted twice as much as other performance measures.
ACO Health IT exceeds the “meaningful use” of an EHR with IT needs for:
• Data Aggregation• Care Coordination (E.g., Referrals) and
Population Management• Revenue Cycle Management and
Reporting
ACO Tools of the Trade• Membership and Provider Network
Management Systems• Prospective and Retrospective
Payment Systems• Utilization Trending and Reporting
Systems• Patient Portals and PHRs
ACO Tools of the Trade• Patient Survey Tools• ACO-wide and Clinic-wide Digital
Dashboards• Business Intelligence Tools• Data Repository• Patient Population Management
Systems
ACO Tools of the Trade• EHR-based PQRS (GPRO)• Advanced HIE
ACO Blueprint
Patient EngagementStrategies
Care Coordination
Data and Reporting
Continuumof Health Care
“In-Network” Referrals
PCPs and SCPs
Physician-Driven Operations
ACO Leadership
ACO Internal and External Governance
Hea
lth IT
Patient-Centered
Care Using PCMH
Long-Term ACO Decision Points
Extend Valuecreated to other Payers/Employers
Systems and Processes must consider:• Participant Performance Metrics• Operations/Data Exchange• Medical Management (E.g., Case
Management and Utilization Review)• Provider Contracting
Systems and Processes must consider:• Product Development/Benefit Design• Marketing and Communications
Requires clearly identified Champion (E.g., CMO)
Requires Community-Wide “Buy-in”
Health IT & ACO - Maturity
Beginner
Successful HIT Requirement
BeginnerMilestone Technology Required
ACO Risk and Revenue
Management
Care Continuum Cost Accounting for Target Clinical Events and/or
Chronic Conditions
• Membership Information Tools• AR Systems
ACO Beneficiaries
Patient Engagement; Episode of Care
Management; ACO Patient Support; "In-Network"
Referral Guidance
• Patient Portals• Patient-Specific Education Tools • Referral Management System
Successful HIT Requirement
BeginnerMilestone Technology Required
ACO Care Management
Across Continuum
Provider Network Development; Case
Management; Protocol Compliance Tracking and
Provider Utilization Reporting
• Case Management Tools• Population Management Tools• Digital Dashboards
Clinical Information
Exchange
Read-only access based on user request (E.g., fax);
Static Information
• e-Fax• Secure Email
Successful HIT Requirement
BeginnerMilestone Technology Required
Data-mining, modeling with financial and
clinical analytics/metrics
Non-aggregated and single-patient focused;
episode / encounter data analysis; post-event
analysis; clinical or financial
• Business Intelligence Tools (Reporting)
ACO Beneficiaries CMS EHR Meaningful Use Stage 1
• ONC 2011/2012 Certified EHR Technology
Intermediate
Successful HIT Requirement
IntermediateMilestone Technology Required
ACO Risk and Revenue
Management
Provider Network Management and
Contracting; Bundled-Payment Administration;
Payment Allocation
• Case Management Tools• AR Systems
ACO Beneficiaries
Pro-active care management; Social
Networking (provider to patient); Evidence-based
Protocols
• Patient Portals and Secure Email• Patient survey tools• Possible social networking (E.g., Forums, Blogs, etc.)
Successful HIT Requirement
IntermediateMilestone Technology Required
ACO Care Management
Across Continuum
Coordination of Care through HIE; Patient-
Centered Medical Home Anchor
• Case Management Tools• Population Management Tools• Digital Dashboards• HIE• Lab Interfaces• Data Repository
Clinical Information
Exchange
Production HIE using CCD, ingest only; Dynamic Information; Push of
Information to Patient Portals
• Limited HIE• Patient Portals
Successful HIT Requirement
IntermediateMilestone Technology Required
Data-mining, modeling with financial and
clinical analytics/metrics
Population Management; Continuum data
aggregation; Predictive analysis and modeling
• Dashboard analytics and metrics• Care Site-Specific Analytics• Business Intelligence Tools• Data Repository
ACO Beneficiaries CMS EHR Meaningful Use Stages 2 and 3
• ONC 2013/2014 Certified EHR (Stage 2 MU)• ONC 2015 Certified EHR (Stage 3 MU)• EHR-based PQRS (GPRO)
Mature
Successful HIT Requirement
MatureMilestone Technology Required
ACO Risk and Revenue
ManagementFull Risk Management
• Member Network Management Systems• Provider Network Management Systems• Prospective and Retrospective Payment Systems• Utilization Trending and Reporting
ACO BeneficiariesPreventive and Chronic Disease Management; Lifestyle Intervention /
Consultation
• Patient Portal• PHR• Patient Survey Tools• Remote Monitoring and Self-Management Tools • Social Media, at large
Successful HIT Requirement
MatureMilestone Technology Required
ACO Care Management
Across Continuum
Established evidence-based disease management and wellness protocols; Patient
Health Maintenance Compliance; Provider Referral Management
• Case Management Tools• Population Management Tools• Digital Dashboards• Advanced HIE• Lab Interfaces• Data Repository
Clinical Information
Exchange
Fully digestible, real-time production HIE across full
continuum; Full Patient PHR
• Full, Bidirectional HIE• Patient Portals• PHR
Successful HIT Requirement
MatureMilestone Technology Required
Data-mining, modeling with financial and
clinical analytics/metrics
Real-time Population Management using
aggregated data across continuum of care; Provider
and Patient analysis; Dashboard analytics and metrics across continuum
• ACO-wide Digital Dashboard analytics and metrics• Business Intelligence Tools• Data Repository
ACO Beneficiaries
Market-specific, network and provider Clinical
Quality Measures (CQMs); Behavioral Economics and
Analysis; EHR-based Reporting
• ONC Certified EHR Technology• EHR-based PQRS (GPRO)• Evidence-based Clinical Decision Support Repository and Tools
SuccessEHS & ACOs
SuccessEHS ACO Standards include• Prospective / Retrospective Payment
Systems• Utilization Trending and Reporting• Evidence-Based Clinical Decision
Support• Patient Survey / Questionnaire Tools
SuccessEHS ACO Standards include• Population Management Technology• Digital Dashboards• HIE in compliance with IHE Standards• Patient Education• Lab, Radiology and Device Integration
SuccessEHS ACO Standards include• Public Health related Integration
(E.g., State Labs, Immunizations Registry)
• PCMH Relevant Technology and Toolkit – BIG
• Datacenter – BIG• EHR-Based PQRS Reporting - BIG
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