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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