With payers embracing value-based reimbursement, more and more physician practices and hospitals are participating in accountable care organizations (ACOs).
ACOs are formed when a group of healthcare providers (primary care physicians, specialists, hospitals, non-physician providers) come together and collectively agree to become responsible for the financial and quality outcomes for a defined population. With the Medicare Shared Savings Program (MSSP), ACOs are rewarded for spending below projected costs by sharing in a portion of the savings earned. They also take on financial penalties for spending above projections. Physicians in an ACO work collaboratively to keep patients healthy and limit unnecessary healthcare spending. The goal is to improve and maintain care quality for patients, and that means demonstrating adherence to quality measures and monitoring patient performance.
For ACOs to be successful, they need to have the ability to seamlessly share information. Most patients—especially those with chronic disease—get care from more than one physician or facility, so technology must be in place for patient data to be easily managed between multiple providers and hospitals. This helps to eliminate duplicate services and treatments.
Electronic health records (EHRs) are an integral tool in an ACO’s IT infrastructure, helping to generate and manage data across the continuum of patient care. With Medicare and commercial payers continuing to encourage healthcare providers to cut costs and improve quality as they strive to reach goals for value-based reimbursement, providers need the right technology in place to meet the pathways set forth by the Medicare Access and CHIP Reimbursement Act of 2015 (MACRA).
Fortunately, EHRs have evolved to help meet the unique needs of ACOs. When your ACO is deciding on a solution to implement, there are many features to consider. When mapping your EHR strategy:
- Know your goals. These likely include improving quality of care, cost savings, and improving population health. Determine your priorities to reach these goals and then determine the tools and features needed to get there.
- Get the tools that help you share data. Since a patient sees multiple providers at multiple care sites, the technology must communicate not only with a single physician or location, but also across the ACO network and in different institutional settings.
- Think trends. Part of improving population health means the ability to drill down into patient data and identify trends. EHR tools or interfaces can turn data into actionable information at the point of care to identify high-risk patients and better manage their care.
- Pay attention to the quality measures. Useful and accurate reporting to CMS is a must. Make sure the EHR has the ability to track and report your specific quality measures from the clinical data in the EHR to help you identify and close gaps in care.
- Don’t forget patient engagement. It’s important that patients take responsibility for their health and patient engagement is a big part of quality measurement. An EHR should deliver access to a patient portal for patients to log in to view their record, lab results, and plan of care.
- Remember the 24/7 rule. You’ll need a proven, web-based platform that can be reached anytime, anywhere. Your practitioners don’t only work at the office or during typical office hours; adopt technology that empowers them to do their best work.
- Consider the template. Your facilities and your practitioners are not all alike. A cookie-cutter solution won’t do. Implement an EHR with easy-to-use, customizable templates to help drive efficiencies.
- Go for deeper integration. Of course you will want the ability to write clinical notes and view lab and radiology results in an EHR, but also consider ePrescribing capability, and the ability to interface with patient scheduling and claims/payment processing tools. An EHR solution should integrate across the continuum of care.
- Be current. By 2019, CMS is requiring that you utilize an EHR with more stringent certifications. Make sure that your EHR will meet these requirements.
- Think about enhancements. Technology is always improving. It’s important to think about what you may need to add to your EHR. Are there any third-party applications or technologies that can help enhance the EHR capabilities or augment what you have in place? How open is the platform or system architecture to innovative technology – like HL7, SMART on FHIR, or Blockchain? Choosing an EHR that is forward-thinking in its approach and design can help you gain efficiencies and reduce repetitive tasks.
Think of the EHR as part of the foundation to help your ACO and your patients be successful. Ultimately, the tools you choose will determine the information you gather and access, helping you make informed decisions that keep patients healthier and improve your workflow at the same time.
