Accountable care and accountable care organizations (ACOs) have received much attention in the healthcare community. This past spring, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule on “Shared Savings” ACOs required by the Affordable Care Act (ACA). This proposed rule, like most, received many critical comments. This response, including negative responses from many potential ACOs, has led some to think that the concepts of accountable care and “ACOs” will not be long for this world
My own view is that accountable care as a concept and “ACOs” as a label, will endure, with a major tailwind being the release of final CMS Rules on Shared Savings ACOs in September or October. Another driver will be the selection of Pioneer ACOs, a related program of CMS’s Center for Medicare and Medicaid Innovation (CMMI) for organizations already acting as ACOs. Even as many disagree with proposed and perhaps final regulations, current government and private sector dynamics, including potential payment cuts, will drive strong provider interest in ACOs. Notably, at a recent GE Healthcare user group meeting, some customers reported that they had already applied to be Pioneer ACOs. For some provider organizations, non-public approaches to accountable care include the creation of patient-centered medical homes and ACO-like arrangements with private payers.
Accountable care and ACOs emerge from the widely shared and bipartisan critique of current payment systems as rewarding volume, not value. Both concepts extend beyond Medicare or other government programs and draw on a mix of tools and techniques under the broad accountable care tent. In some cases, these methods will be part of a formal ACO, in others, they will be implemented by one or more provider organizations at less than a full ACO. Accountable care tools include population health management, bundled payments, full and partial capitation, patient-centered medical homes, predictive modeling, and quality and utilization reporting.
Healthcare IT (HCIT) is the foundation of any accountable care approach, drawing on electronic health records (EHRs), health information exchange (HIE), and revenue cycle/administrative systems, as well as specialized systems focusing on such areas as population health management, case and disease management, patient safety, and clinical decision support. HCIT is central to components of accountable care such as patient engagement, care coordination, and population management. And of course, an overriding focus of accountable care involves using HCIT to measure and improve quality, safety, and cost, for such priorities as cardiovascular disease and healthcare acquired infections (HAIs).
The current EHR incentive program, focused on meaningful use and EHR certification, seeks to ensure a baseline of EHR capabilities that can support accountable care. Notably, the HCIT approach in the two CMS ACO proposals reflects a complementary and much less prescriptive approach, emphasizing intermediate and final outcomes and encouraging ACO applicants to adopt strategies that use HCIT to implement such imperatives as patient engagement and care coordination This outcomes-focused strategy necessitates that HCIT solution providers to listen to customers and develop solutions that meet their needs. Broad federal, state, and private sector requirements will create strong provider demand for HCIT best practices while leaving to HCIT developers and their customers how best to achieve accountable care goals.