ACO Summit Highlights

Accountable care is here. Already today, 30 million people (about ten percent of the US population) receives care from provider organizations participating in an accountable care model, whether that be the Centers for Medicare and Medicaid Services’ (CMS) Shared Savings Program or Pioneer ACO Model, or one of the innovative integrated models being rolled out by commercial payers. This was the proclamation of many speakers at the second annual ACO Summit held in Austin, TX in January 2013.

Accountable care is an emerging model in which groups of physicians and other providers, such as hospitals, come together to provide high quality, coordinated care for a group or population of patients. The provider’s payment is based on results reflected in established quality measures, rather than fee for service. The trend toward accountable care, in which providers increasingly assume financial risk, is only expected to grow as provisions of the Affordable Care Act kick in and employers continue to look for ways to slow unsustainable growth in healthcare costs. It won’t happen overnight, but it is projected that accountable care will become the predominant payment model over the next ten years. This shift will occur as savvy healthcare leaders, healthcare innovation specialists, and financial analysts figure out how to navigate the transition from fee-for-service payment to value-based purchasing or accountable care. But it is already clear that care quality, population health management, and patient engagement—elements of the Triple Aim— are critical to the success of accountable care.

While hospitals may play a large role in terms of the organization, contracting, and resource management for an accountable care organization (ACO), they will play a much smaller clinical role. Care coordination provided by teams of physicians and other healthcare specialists and supplanted by advanced health information technology will comprise the core of accountable care. Care management models, such as the patient-centered medical home, are the vehicle for accountable care, and high quality healthcare information—which supports that care coordination and enables sophisticated analytics—is the fuel for accountable care.

Electronic health records are only the beginning of the information technology capabilities necessary for accountable care; just as critical are predictive data analytics, health information exchange that brings together information from a variety of sources, and software applications that support patient engagement. In fact, local and regional health information exchanges expect to play an important role in providing community-level health information to providers and payers, as well as patient portals and other interactive tools for patients. Patient/consumer experience is recognized as being essential in driving down costs and realizing value in accountable care.

Accountable care represents a major shift in healthcare. HIM professionals need to closely monitor its development, its impact on revenue lifecycle management, and understand how they can best support it. Implications for HIM professionals include the need to assess or reassess consumer-facing health information practices; data capture and classification (coding) that supports quality measurement; and data integrity that supports health information exchange for care coordination, analytics, and patient engagement.

Main takeaways from the recent ACO Summit, held to examine the healthcare indutry’s progress in transitioning to accountable care organizations.

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