The Centers for Medicare and Medicaid Services said Tuesday that nine of the 32 pioneer ACOs were dropping out, and two of the ACOs shared losses totaling approximately $4 million. ACOs are one of the big ideas of U.S. healthcare reform -- that by paying providers to keep people healthy, rather than for the number of procedures they do, care will improve and costs will fall.
At this critical juncture of the ACO program, we spoke with technology leaders at three pioneer ACOs that plan to stay in the program. These leaders highlighted three key areas where information technology provides a foundation for successful ACO operation.
At the core of information exchange is the adoption of an electronic health record system. If implemented to allow data sharing, EHRs allow multiple doctors to manage patient care from exam room to hospital bed to the patient's home.
Atrius Health uses Epic's EHR system at multiple levels. In the exam room, the system is used to document the patient visit, order medication or laboratory work, and check if preventative care is up-to-date. The system also provides "decision support" information that helps physicians manage care to make it well-coordinated and less costly, said Richard Lopez, the chief medical officer at Atrius Health. Decision support can give physicians the option of generic medication over brand medication, and will display the costs of certain labs.
"We do this not so much to impact what the clinician is going to do, but to sensitize clinicians to the cost of services provided," Lopez said.
Atrius also uses Epic to facilitate communication between primary care physicians and specialists as well between Atrius's preferred hospitals.
Patient engagement, an increasingly hot topic in healthcare IT, plays a role in ACO information exchange as well. Patient engagement is about improving care but it's also a smart business move, said Bill Spooner, CIO at Sharp Healthcare.
"We want our patients to be sticky," he said.
In other words, Spooner wants patients to come back to Sharp for their care. Sharp does this by creating a substantial online presence and patient portal. Atrius and Beth Israel Deaconess Medical Center in Boston also have patient portals where patients can view upcoming appointments and test results, among other personal information.
Information exchange has boundaries, at the policy level and the technical level. The diversity of privacy laws in the U.S. makes the creation of a uniform national EHR system challenging, said John Halamka, CIO at BIDMC. Interoperability of different vendors' EHR systems is also a challenge, as "there aren't uniform standards for these systems to talk to each other," Lopez said.
Adoption of new technologies is also challenging. Just because an ACO has adopted an EHR system doesn't mean it's being used effectively, Spooner said.
"There is clearly some loss of productivity in the early days of learning EHR, and the question is how to get through that as quickly as possible," he said.
Atrius's Lopez said there are varying degrees of clinician competence with these new systems.
"Some physicians feel it slows them down, and that it's a little clumsy," he said. "There's a continuous effort to get clinicians to be proficient with the technology so that using this fantastic tool doesn't slow them down."