HITPC: New accountable care group offers plans, goals

During the April 8 Health IT Policy Committee, the co-chairs of the new Accountable Care Work Group detailed their outlook for the committee and its goals.

In setting the work group’s recommendation areas, “we took a broader purview than what might appear in Meaningful Use recommendations,” said Charles Kennedy, MD, head of Aetna Aligned Care Solutions in Hartford, Conn. “That was a conscious decision strongly supported by all members.”

Efforts to establish the work group began last April with a look at Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) requests for information and literature of health IT and accountable care. A public hearing was held in December.

The work group’s formal charge is to provide a set of recommendations to the HITPC regarding how ONC and the Department of Health & Human Services can advance priority health IT capabilities in a variety of accountable care arrangements to support improvements in care and health while reducing costs.

The work group’s rationale is the idea that it is important to look at policy through the lens of the unique business and clinical requirements of accountable care models, said Kennedy, and the health IT infrastructure to support population health management and other accountable care capabilities goes beyond core use of EHRs for patient care. The work group can identify priorities among the set of common health IT capabilities that help providers succeed under a range of different value-based payment arrangements, he said.

The work group developed the following six draft recommendation areas:

• Health IT adoption and infrastructure
• Access to administrative and encounter data
• Exchanging data across the healthcare community
• Data portability for accountable care
• Clinician use of data and information to improve care
• Streamlining the administration of value-based programs

The work group considered the following criteria for recommendations: whether it was clinically important, able to be driven effectively by regulation; a business imperative; and unlikely to arise from current market forces alone.

“As we define accountable care, everyone speaks of the notion of moving from volume to value,” said Kennedy. “What does that really mean? What are the technical or health IT and technology implications beyond health IT for success in a value-based care system?”

The foundation of accountable care is tying the interventions of providers to the health and wellness and disease management of a specific population, he said. There is a notion of efficiency.

“I think this is a very important opportunity as we have worked over the past several years trying to deploy technology that achieves the triple aim, then have that retarded by the very payment system that supports our healthcare infrastructure,” Kennedy said. “Accountable care really represents an opportunity to have both financial incentives as well as underlying technologies align in a common direction associated with the triple aim.”

The work group intends to look at accountable care through the lens of providers and the business and clinical requirements necessary to help them make the transition to accountable care as well as establish themselves in this new way of operating as a delivery system, he explained.

During the public hearing, “we heard great concern about data being siloed,” said co-chair Grace Terrell, MD, of Cornerstone Health Care in High Point, N.C., “which makes it difficult to deliver effective care to patients. The challenges are being experienced very acutely, particularly when they were not exchanging information with local hospitals.”

Terrell said CMS should consider mechanisms that would ensure, at a minimum, that organizations participating in public database models are sharing data to the degree that it’s technically feasible to do so. CMS could add to current survey and certification guidance and add standards that institutions must electronically transfer discharge summaries to treating providers in a timely manner, she said.

Erroneous reporting continues to hinder the sharing of protected health information, even when sharing is permitted, Terrell said. “That’s giving traction to a lot of siloed behaviors.”

Regarding the data portability priority, Kennedy said the work group intends to pursue greater specificity in federal interoperability standards around transactional data and strengthen data portability elements in certification criteria.

They also intend to develop future certification criteria to promote access to EHR data by other types of health IT systems to support population health management, operations, financial management and other uses; increase availability of data from remote monitoring devices to engage patients more deeply in their care; use EHRs to identify simple discrepancies as well as more complicated analytics to determine which interventions would be the most effective.

The work group’s research to date revealed “hunger for semantic interoperability and structured exchange couldn’t have been stronger,” said Kennedy. "We got a fair amount of feedback to expand certification criteria to include other functions as well as responsiveness and performance." They also want to extend the physician-patient relationship beyond the 15-minute office visit to "more of a continual relationship where data are received from the patient and there is an ability for our health IT solutions to react and help support the patients so they can stay in the home longer and avoid admissions."

Summing up the work group's planning efforts, “the goal was to go a little farther afield,” said Kennedy, “but we felt that was very important because of the infancy of accountable care as a provider model, the uncertainty associated with how to make it successful but the universal acceptance that health information technologies are critical to making the models a success.”