Models, accountability and health IT

Mary Stevens, editor, CMIO

Care to comment on the proposed guidelines for accountable care organizations (ACOs)? You have until June 6. CMS wants to hear from you, said John Pilotte, CMS' acting director of performance-based payment policy staff, during a National eHealth Collaborative webinar on accountable care and payment models yesterday.

During his discussion of the proposed ACO framework and the ACO Pioneer Program, Pilotte made the case for how an accountable care model of payment could work. It made an interesting rebuttal to some of the more publicized comments on the proposed ACO guidelines, including last week's letter from several members of the Senate Finance Committee.

For her part, fellow speaker Dana Safran, ScD, senior vice president for performance measurement and improvement of Blue Cross/Blue Shield of Massachusetts, said that organization’s Alternative Quality Contract (AQC) payment model isn't an ACO, although it has some of the same characteristics and an early cost containment record that any ACO would envy.

Both speakers spelled out the extensive role of health IT in any cost-containment effort.

"In the proposed ACO rule, we proposed clinical integration, along with a requirement that 50 percent of primary care physicians be meaningful users in the HITECH incentive program," Pilotte said. "We did this not only as means to provide clinical infrastructure, but also to [enable] ACOs to tap into the EHR incentive program revenue stream."

"I would start with EHRs," Safran concurred. "Groups that have EHRs or have good health IT infrastructure are advantaged in their ability to do this work. Several ACQ groups are at very early stages of EHR adoption. They've demonstrated the ability to be successful even in the absence of that, but all are on the path of implementing EHRs."

Having a pervasive IT infrastructure in place will improve communications, "but realistically, we’re quite a long way from having it in place across provider organizations to the patients," Safran said. For example, while many provider organizations are using effective EHRs, five clinical outcome measures still don’t have population data sources available electronically to enable assessments, so providers have to include those data in spreadsheets. "With creativity, we’re getting around those challenges, but it will be much better process down the road," she added.

The same can be said for federal efforts to get ACOs moving in the same general direction.

Getting around challenges is a big part of health IT in any hospital, and it can be tougher for smaller facilities. CMIO wants to showcase small hospitals' big IT ideas (and measurable results) for improving patient care, streamlining workflow and driving quality. If you want to nominate an ambulatory hospital or inpatient facility with a small patient census and an in-house IT crew of one or more, please contact me at mstevens@trimedmedia.com.

Mary Stevens,
Editor of CMIO