In December 2011, the U.S. Department of Health and Human Services (HHS) released the names of 32 health organizations selected to participate in their Pioneer Accountable Care Organization (ACO) model, which launched just over one month ago on Jan. 1.
Chosen from 80 applicants, these 32 Pioneer ACOs are testing several new payment arrangements, which HHS estimates could save more than $1 billion over five years and improve care for 860,000 Medicare beneficiaries. Organizations selected (.doc) are truly at the forefront of the movement toward a new coordinated delivery model designed to reduce health costs and improve the quality of care patients receive.
With the help of Andrea Littlefield (@BangorBeacon), I asked health IT leaders from Pioneer ACO Eastern Maine Healthcare System to share their experiences participating in the program, about the IT infrastructure they have in place to coordinate the delivery of care, and any advice they would give other health IT professionals working toward creating an ACO.
EMHS’ Pioneer ACO includes three of the system’s member hospitals: Eastern Maine Medical Center, The Aroostook Medical Center, and Inland Hospital.
Special thanks to EMHS’ Catherine J. Bruno, FACHE, vice president and chief information officer; and Ralph Swain, corporate director of information systems, for collaborating and providing the following answers.
When Eastern Maine Healthcare System was selected to be one of the 32 Pioneer ACOs, what was your immediate reaction? (Was it complete celebration, full of high fives and champagne toasts? Or was it, ‘OK here we go, let’s get to work… there’s no looking back now?’)
We are very excited about the opportunity to participate in the Pioneer ACO. I think our reactions were a mix of what you mention – we were elated, we celebrated, and then rolled up our sleeves and got to work. As a healthcare leader, EMHS looks forward to helping shape the future of healthcare delivery and reimbursement strategies.
Prior to Eastern Maine Healthcare System’s selection as a Pioneer ACO, a technology foundation obviously had to be in place. Did EMHS form or participate in an HIE prior to your acceptance to the Pioneer program? Are all connected providers participating in the HIE also participating in the ACO?
EMHS is the lead organization for the Bangor Beacon Community grant (received in May 2010). Through Beacon, we have been able to build upon our already strong foundation in health information technology. We work directly with HealthInfoNet (HIN) – Maine’s statewide health information exchange and one of our Beacon partners – to improve connections to the exchange as well as expand the data collected through HIN to assist our practices in providing more efficient, better managed care to their patients, while reducing costs.
EMHS affiliate Eastern Maine Medical Center (EMMC) was one of the first hospitals to participate in HIN’s demonstration project beginning in 2008.
Due to the constraints of the Pioneer ACO rules, not all of our Bangor Beacon Community partners were eligible to participate in the first phase of ACO. However, we are working with many of our EMHS affiliated practices in Bangor (EMMC), Waterville (Inland), and Presque Isle (The Aroostook Medical Center – TAMC) – a total of 9,000 potential patients – to provide more efficient, better managed care to these patients.
All of these providers have electronic medical records and are, or will be, connected to the HIE.
With different providers involved in the ACO, how are technology decisions made? Is there a designated lead for IT decisions? How are the operational expenses for the IT infrastructure funded by the ACO? Are proceeds from the shared savings used to support the IT infrastructure?
Currently, providers associated with the Pioneer ACO are largely employed practices and therefore work with the same technology platform. EMHS has policies that govern the selection of systems that encourage the use of core vendor systems. A Corporate Director of Information Systems (IS) is a member of the ACO team and is coordinating the technology discussions and decisions with the IS Department. Marginal costs clearly will be required for the ACO, will be included in the ACO budget and are planned to be covered by shared savings.
Are there any immediate IT infrastructure gaps that will need to be filled to address ACO quality measures?
The primary care practices use a common electronic medical record (EMR) that has an associated disease registry. This will be used to capture the 26 clinical quality measures. We are also working with the vendor of that application to ensure that all measures are captured.
Even though the ACO loosened the requirement for having ONC-certified EHRs, will most of the providers in the EMHS ACO have a certified EHR?
All providers currently use a certified EHR.
What steps are in place to ensure patient data safety and that interfaces remain operational?
EMHS IS has a comprehensive policy and process for ensuring the security of patient information that will be applied for ACO activities, as well. These policies include required data use agreements and business associate agreements with outside vendors. Transfer of data to any outside parties will be done with secure file transfer processes.
What has been the biggest Health IT challenge so far?
The ability to visibly identify managed health members in the major clinical systems on an ongoing basis has proven to be more challenging than it initially appeared. We are currently inventorying the full set of required capabilities to discover and prioritize gaps.
What advice do you give other health IT professionals who ask what IT steps they need to take to be prepared to participate in an ACO?
Start now to define the required ACO processes and the required systems capabilities, then define the system functionality that will be required to start out. We would be in a difficult position if it were not for the work done within the Beacon Communities grant. This experience provided us with many lessons learned and best practices, specifically regarding data management and evaluation, workflow, and practice improvement.
Lastly, how much discussion do you have with your staff about the how ACOs are changing the delivery of healthcare?
Since receiving the designation, we are communicating on a regular basis with our employees around the system about ACOs and how healthcare delivery is changing. We want our staff to understand the role EMHS is taking in advancing new payment models and the way we deliver healthcare to our patients.
Simultaneously, we are initiating a new employee health plan, called “In System Rewards,” which uses many of the lessons learned through our Bangor Beacon Community. In System Rewards will lead to improved care for our employee/patients who have chronic diseases by adding care coordination services and more closely monitoring those patients.