Healthcare organizations across the U.S. are investing significant resources in re-architecting their care delivery infrastructures to enable them to adapt successfully to new, value-based Accountable Care Organization (ACO) payment and delivery models.
As these entities prepare to go “at risk” and take outcomes-based capitated or bundled payments, they face a broad set of challenges. These challenges range from acquiring or partnering for resources that will enable them to deliver and control the full continuum of care, to understanding their new cost structures and determining if they can survive and thrive financially in an ACO world.
One of the most complex and critical aspects of building the foundation for a successful ACO is developing an IT infrastructure that will enable clinicians and administrators to access and share the clinical and financial information they need, and allow them to streamline and automate their processes to ensure the most efficient clinical and administrative workflows. As organizations seek to integrate data and workflows across community practices, acute care, long-term, behavioral health and rehab facilities, the technical and organizational challenges can become daunting. Fortunately, today we can draw on the experience of a number of entities that have adopted health information exchange (HIE) and population health management technologies for guidance on the road to becoming a successful ACO.
Drawing from the lessons learned by large integrated delivery networks (IDNs) and HIEs, early ACOs have succeeded in building IT infrastructures that effectively enable collaboration around accurate, comprehensive and up-to-date data, without requiring constituent entities to standardize on monolithic systems or put an undue burden on their sometimes limited technical resources. The best practices that have emerged from those early implementations offer valuable guidance for second-wave organizations taking the ACO path.
According to the U.S. Department of Health & Human Services, more than four million Medicare patients are under the care of an ACO today,1 and a recent study by Premier indicated that ACO participation is expected to double by the end of 2014.2 Chances are your organization is somewhere along the path to accountable care and looking for answers to the tough IT challenges you face. This paper will boil down the knowledge gleaned from ACO rollouts to give you some of the most important high-level insights from those projects and then detail critical success factors for ACO and population health strategies.