The feds have yet to explain exactly what's needed to participate in an Accountable Care Organization, but many providers are ready jump on the bandwagon anyway.
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More than a third of healthcare providers plan to participate in the Centers for Medicare and Medicaid Services' ACO Shared Savings Program, according to a recent KLAS survey of 197 providers. This despite their concerns that the advanced technology needed threatens to take money and IT skills away from Meaningful Use, ICD-10, and other IT projects.
The report, entitled Accountable Care: Providers Forge the ACO Trail, also found that while the federal government has yet to release the final rule for ACOs, most providers believe that the ACO framework outlined in the Patient Protection and Affordable Care Act (PPACA) of 2010, will be part of the future of U.S. healthcare.
Under the ACO delivery model, groups of healthcare providers will collectively coordinate and manage patients' long-term care. ACOs that show a high level of quality measures while cutting costs will receive higher reimbursement rates. Those ACO's that don't meet cost reduction or quality measure targets will receive lower reimbursements.
Since many healthcare delivery organizations are already on their way to raising quality measures through the adoption of electronic medical records and other health information technology to meet Meaningful Use requirements, a significant number will likely be ready to participate in an ACO.
"Many organizations are ready to jump on the ACO bandwagon, despite a lack of clarity of where the wagon is heading exactly or what the road is going to be like," Colin Buckley, the report's co-author told InformationWeek Healthcare. "On the one hand, some see accountable care as a solution to rising costs--perhaps the future of healthcare or even a potential financial lifesaver for their own organizations. On the other hand, there is great concern around how expensive and risky the CMS program seems to be based on the proposed rule."
Although the poll showed that 36% of providers plan to participate in the CMS program, 22% said they would seek other alternatives. They plan to establish similar ACO models outside of the CMS program such as homegrown accountable care models or other government-shared savings and value-based purchasing programs. Buckley said he wouldn't be surprised if a good portion of the 36% eventually shifted to the 22% camp.
The KLAS survey also found that many of the 37% that were unsure of their ACO approach still spoke of the expected benefits of ACOs, even though they had not formulated a plan and did not have the time or money to develop one. Only 5% of the nearly 200 organizations said they had no intent to participate.
Among the barriers to participation in an ACO, providers said there were three areas of concern:
-- Technology: ACOs will require that providers rely on technology that goes beyond supporting Meaningful Use requirements. Providers will have to acquire business intelligence software to collect and analyze clinical data, as well as technology to manage revenue, risks, and payment systems. While 43% expected to establish an ACO with current staff, others will turn to third parties for the IT skills they lack internally.
-- Administrative and process tasks: Aside from legal issues, the ACO model will demand sharing and analyzing data, distributing bundled payments, maintaining revenues, and managing risk.
-- Culture: 37% of respondents expressed concern that getting staff, physicians, and patients to buy into the new care strategy will require behavior and relationship changes within and between organizations.
The report also found that no single vendor can offer a comprehensive set of IT tools that fulfill all ACO's requirements. Nevertheless, many providers are seeking to leverage a combination of technology solutions to meet ACO requirements.
Among those vendors that providers said had the best array of technology to manage an ACO, healthcare vendor Cerner topped the list because it has an almost complete clinical suite, good analytics tools, a full health information exchange with good connectivity to non-Cerner sites, and a long-term care product. However, the KLAS report said Cerner has weaknesses in its IT offering: It lacks an integrated ambulatory billing system and has mediocre ambulatory EMR functionality. Cerner is followed by Epic, Allscripts, GE Healthcare, and McKesson in that order to round out the top five vendors that providers say are most ACO-ready.
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