In the process of reading through the 400+ page rule on Accountable Care Organizations, a thought consistently surfaces: this program has the potential to change health care in this country.
If ACOs succeed in motivating providers to improve outcomes and lower costs for a population of Medicare beneficiaries, then I suspect the private insurers will follow and a new era of care will begin.
But how do we get there from here? Even with certified EHRs and state HIEs in place, providers need new applications in order to deliver on the ACO vision. A new category of technology will likely emerge that optimizes the performance of cross-functional and cross-organizational teams. As opposed to legacy EHR and HIE technology, ACO technology will enable the otherwise disparate group to manage itself as a single entity with aligned clinical and economic goals. For example, ACO software might include:
- Reporting: not just a mechanism to review progress against the 65 quality measure reports, but also a means to report against underlying trends on a single patient and/or provider level. For example, a provider should be able to ask the system how many MRIs a particular patient has had over a certain time period. Moreover, the system should be able to forecast progress against financial goals and estimate potential bonus payments.
- Collaboration: a care team should be able to quickly assemble around not only a particular patient, but also a particular episode for a particular patient. The distribution of information for the care team should be as seamless as sharing photos on Facebook, but with the security and authentication of a mission critical clinical system. Information from encounters and consults should be automatically captured by the system so that minimal incremental data entry is required.
- Patient engagement: not to be confused with a mechanism by which a patient can make an appointment and request medical records, this software would be complement to care management. Providers might use it not only to offer virtual patient visits, but they also might use the portal to conduct video conferences among a larger care team, including PCP, specialist, case manager, and patient. Some patients might use the portal as a tool to manage and monitor their ongoing health.
And these examples are likely just the tip of the iceberg. CMS estimates that ACO start-up costs will fall in the $1-2 million range. If ACOs have the potential to transform health care, should CMS subsidize the start-up costs for providers? Many of the providers I know are already spending their limited spare time and resources on EHR upgrades in order to meet Meaningful Use requirements. For many, investing in ACO technology is simply not possible without outside help. A bootstrapped ACO may try to peice together an ACO infrastructure from existing IT systems. That is a risky approach.