Healthcare Reform Is Here, Like It Or Not

Many observers still wonder whether the Supreme Court will squash key provisions of the Affordable Care Act later this year. But the fact is that right now critical elements of healthcare reform are unfolding quickly. And health IT CIOs are painfully aware that many of these elements require fast action by their departments.

Accountable care organizations--groups of hospitals, doctor practices and other healthcare providers working together to deliver coordinated patient care-- are the buzz words in healthcare reform. ACOs, which are already sprouting up across the country, involve new payment models that replace traditional fee-for-service with bundled, shared savings and population-based payments, and require intense focus on quality, performance, patient outcomes, and reduced costs.

The Centers for Medicare and Medicaid Services in December named 32 Pioneer ACOs to essentially be guinea pigs in testing these new models. But while there's still a lot of work that these early adopters need to do as they transform into new ACOs, many of the healthcare providers picked for the CMS Pioneer program are already leaders in IT.

"The Pioneer ACO Model was designed specifically for organizations with experience offering coordinated, patient-centered care, and operating in ACO-like arrangements," said CMS in a statement. "The selected organizations were chosen for their significant experience offering this type of quality care to their patients, along with other criteria," said CMS.

Among the requirements: "By the end of 2012, Pioneer ACOs must attest and CMS will confirm that at least 50% of the ACO’s primary care providers have met requirements for meaningful use of certified electronic health records (EHR) for receipt of payments through the Medicare and Medicaid EHR Incentive Programs," according to CMS.

Some of the chosen Pioneer ACOs, including Boston-based Partners Healthcare and Beth Israel Deaconess, and Sharp Healthcare of San Diego, are already well-known in national health IT circles for their innovation and early adoption of e-health record systems, and computerized physician order entry.

I also suspect that some other Pioneer ACOs with names less familiar outside of their region will become much more well known nationally as their innovative use of health IT catches the spotlight.

Those include players like Atrius Health, a non-profit alliance of six multi-specialty medical groups serving 1 million patients in central and eastern Massachusetts. When it comes to recognition of technology leadership, Atrius has largely operated in the shadow of Partners Healthcare and Beth Israel Deaconess--but apparently CMS was equally impressed with Atrius' IT prowess.

"The Atrius Health groups work closely with academic medical centers and community hospitals to coordinate care across the continuum for their patients," said CMS in a statement explaining its Pioneer ACO choices.

The Atrius Health groups have implemented advanced use of health information technology (including a patient portal for secure electronic communication), chronic disease management, clinical pharmacy programs, Lean care improvement, and innovative ways of delivering care such as shared medical appointments," said CMS. Lean care improvement involves streamlining and optimizing care related processes.

"Everything that comes up in the ACO area has some IT element," said Atrius CIO Dan Moriarty in an interview with InformationWeek Healthcare.

With Atrius' IT plans this year, "we're doing a combination of reprioritizing to make sure what's critical to the ACO is top of list," Moriarty said. That includes "accelerating work in clinical data exchanges and analytics," as well as mobile and telehealth projects.

Yet, "the vision and mission of the organization has always been to provide patient care focused on better clinical outcomes across a set of member organizations not owned by Atrius."

During the next few years, other Pioneer ACOs, as well as other ACO-wannabes in general, will also need to ramp up data sharing and data analysis. Information exchange will be vital for ACO-participating clinicians to coordinate care.

Data sharing helps create safe and effective care plans--including medication instructions, physical therapy, follow-up visits, and wellness programs for surgical patients upon discharge from hospitals.

Data warehousing, clinical analytics, and business intelligence tools will also be critical instruments for evaluating how these new coordinated and preventative care efforts are faring. Meanwhile, decision support tools can help clinicians adhere to best practice and evidence-based standards. On top of all that, new mobile and telehealth applications can help patients keep track of their progress and help them to become more active participants in their care and outcomes.

These IT-fueled endeavors won't be easy for ACOs. But if they're successful, they could be the beginning of significant healthcare transformation nationally.

"Some people won't use the 'ACO' term, they think accountable care won't take form as it is [prescribed] in healthcare reform," said Tom Niehaus, president and chief operating officer of Encore, a health IT consulting firm in an interview with InformationWeek Healthcare. "In any case, shared risk will happen. It's a question of when, not if."

So, roll up your sleeves and get ready.

Marianne Kolbasuk McGee is a senior writer for InformationWeek.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)