ACOs Set to Transform Healthcare

The Nursing Informatics Symposium was a workshop offered on the weekend preceding the HIMSS conference. The symposium provided a glimpse into a more mature electronic health record (EHR) environment—where quality, performance improvement, patient engagement, and reimbursement models are under close scrutiny, and strategies that address those topics center around the EHR.

The same message was clear across the board at the symposium—the EHR has evolved from implementation to the optimization phase and provider organizations are beginning to realize the benefits of EHR technologies in their service delivery models.

Linda Fischetti, RN, MS, vice president of care delivery at Aetna, described Aetna’s work around accountable care organizations (ACOs) in her presentation. ACOs are a key part of Aetna’s tactical approaches to transform the practice of medicine from a fee-for-service payment model to a performance-based system, Fischetti said.

ACOs, which Aetna is helping to develop, have three aims:

  • Improve the individual experience of care
  • Improve the health of populations
  • Reduce per capita costs of care for the covered population..

 

Aetna seeks to help scale to “appropriate” volume as the organization forms new ACOs in order to create a sustainable model for the provider organizations and to deliver care where it is most needed.

Types of ACOs include:

  • Medicare Shared Saving Program—Fee-for-service program
  • Advance Payment Initiative—For certain eligible providers in the shared savings program
  • Pioneer ACO Model—Population-based payment initiative for healthcare organizations and providers already experienced in coordinating care for patients across care settings
  • Non-CMS ACOs (Commercial ACO Model)—Population-based initiative in which payers implement quality improvements in partnership with healthcare delivery organizations in order to achieve shared savings; commercial payer is the entity providing the financial incentives

 

As an organization forms new ACOs, it can assist providers with a broader view of the patient data, such as providing information about visits outside of the provider system to give a fuller picture of the population’s healthcare utilization. As ACOs begin to take more responsibility for populations, they find innovative ways to deliver care and improve health. One example Fischetti noted was of an ACO that repurposed the blood drive van as a “mobile health risk assessment clinic,” providing on-site services to employer groups to help advance healthy lifestyles and mitigate health risk factors through education and screening.

Key areas to address as new ACOs are formed include:

  • Creating a solid population management foundation—customizable quality measure targets, tools focusing on patient engagement, and targeted interventions to decrease emergency department and hospitalization rates for certain conditions
  • Care management enhancements—ability to focus in on high risk members of population; care coordination via evidence-based, action-driven workflow tools; availability of patient-level content; and population health registries
  • Enhanced Data and Analytics—targeted improvements in clinical decision support, and use of advanced analytics to create “actionable intelligence” (data that can be used to improve quality or care)

 

Challenges remain for the integration of data across populations, providers, and payers, and for the development of quality measures that truly improve the care experience and save healthcare costs at the individual, population, and health system levels. As data is integrated between payers and providers, this will create new resources and opportunities for quality measurement and improvement.

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