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Infographic: How an Integrated Skilled Nursing Facility Network Supports Accountable Care

Posted by Matthew Smith on May 21, 2015 2:39:19 PM

In the future, Skilled Nursing Facility ("SNF") readmission rates could be subject to penalties similar to those CMS has put in place for hospitals, such as when SNF readmissions to a hospital occur for certain conditions, within a particular timeframe. To avoid this, many hospitals and health systems are collaborating with SNF providers to improve care and reduce unplanned 30-day readmissions. (Be sure to read The Camden Group's article, Leveraging Post-Acute Care to Address Acute Readmissions here.)

This infographic, created by the Healthcare Intelligence Network, describes how an integrated SNF network supports accountable care. 

Benefits_Integrated_SNF_infographic.jpg

 

Topics: Accountable Care, Infographic, Skilled Nursing Facility

Ten Key Governance Best Practices for Your ACO or CI Program

Posted by Matthew Smith on Jul 21, 2014 12:48:00 PM
By Daniel J. Marino,
President/CEO, Health Directions

ACO, Clinical Integration, GovernanceA board’s most valuable resource is its time.”  That single sentence, from a renowned expert on board and governance matters, serves as the wellspring for some important guiding principles for governance of your accountable care organization (ACO) or clinical integration program.

Following are some best practices your organization can adopt to ensure optimal effectiveness of governance functions and your organization’s overall success in achieving its strategic objectives.

 

1. Screening Tool for Prospective Governance Members

Most population health management-type organizations are comprised of multiple stakeholder groups, some of whom have little history of working together or knowledge of the capabilities and potential conflicts of leadership. In some cases, these stakeholders have historically thought of themselves as competitors to one another. An important exercise for any board is to work through a process for objectively and consistently screening potential board members to ensure suitability. Such a screening process probably should involve some sort of screening for conflicts of interest, but at its simplest level should at least make sure the prospective governance member is available to attend governance meetings at scheduled times.

2. Position Descriptions for Board and Committee Chairpersons and Rank and File Members

Position descriptions are not just for management. A succinct statement of the purpose and expectations of both Board/Committee chairpersons as well as “rank-and-file” Board and Committee members can be remarkably helpful, particularly in underscoring the importance of leaving members’ legacy “stakeholder” organizational interests at the door and acting in the best interests of the enterprise. This is an important first step in building a common culture and preparing for the future, rather than preserving the past.

3. Cycled Performance Review of Board and Committee Chairs and Rank and File Members

Once formal position descriptions for Board/Committee chairpersons and rank-and-file members are developed and approved by the Board, it is easy to use these tools – specifically the duties – as the basis for formal performance evaluation and feedback. It is recommended that Board and Committee chairs be formally reviewed once a year, and that a cycled approach be used for rank-and-file Board/Committee members such that these members are reviewed at least once every two or three years. Performance feedback should be sought from fellow Board/Committee members. An objective third party might be engaged to consolidate (and de-identify) peer feedback, and then review results with the reviewee.

4. Formal Orientation for New Governance Members

It is important to have a steady rotation of new Board and Committee members to ensure all stakeholder represented in Board and committee decision-making, and in building a “bench” of physician leaders knowledgeable of and committed to the organization’s strategies. One effective means of doing this is to have formal orientation governance sessions with the incoming class of governance members. Depending upon the size of your governance, these orientation sessions might be conducted once or twice a year. They should be scheduled at times that are convenient for incoming governance members to attend (e.g. early morning or dinner meeting times). Attendance at an orientation could be a requirement before a candidate is officially seated on the Board or a Committee.

5. Governance Compensation

Some organizations routinely compensate physicians for their attendance and participation in committee work. Other organizations fiercely resist the practice. Regardless of whether you chose to compensate or not, the Board may wish to proactively evaluate the merits of, and formally adopt a policy related to, governance compensation, rather than just respond reactively when asked.

6. Charters & Annual Work Plans

It is typical for a Board, as one of its first orders of business, to develop a governance organization structure that creates a select few committees to do a “deeper dive” into policy matters and oversight activities. While each committee typically reports to the Board, there is often significant interaction among the committees as well. For these reasons, it behooves the Board to clearly articulate the role and expectations of its committees. This can take two forms: first, a “charter” outlining the general roles and responsibilities of each committee, and second, an annual “work plan” outlining what specific activities the committee is to undertake in a particular year. To illustrate, it would be typical for the “charter” of a quality committee to specify that committee as the governance entity in which program measures are to be developed. The “annual work plan” might include a directive from the Board that, this year, it expects the quality committee to develop measures related to cardiology, oncology and orthopedics. Committee charters should be reviewed and changes approved by the Board on annual basis, presumably at the same time that annual Committee work plan assignments are approved.

7. Board and Committee Self Review Process

Boards and committees are collections of individual members, but are also entities unto themselves. Just as individuals’ performance should be reviewed on a periodic basis, it is recommended that Boards and Committees do a collective self-review once a year, perhaps as part of an annual retreat process or in a special executive session.

8. Planning vs. Monitoring

As noted above, a board or committee’s most valuable resource is its time. The role of governance is to set strategy and the role of management is to implement strategy. It would be a revealing exercise to review the agendas of your board over the past year, identifying the proportion of meeting time and content spent on monitoring and looking over the shoulders of management vs. developing strategy and setting policy. How much time was spent looking forward vs. looking backwards at operations?  Ideally, at least 70 percent of Board time should be spent setting strategy, formulating goals and crafting policy. To expedite monitoring functions, it is suggested that the Board develop high-level dashboard reports on critical indicators and other management-by-exception practices.

9. Pro Forma Agenda and Annual Master Calendar of Agenda Items

To help ensure the Board spends adequate time on strategy while still attending to its duties to monitor operations, it can be instructive to develop an annual calendar of agenda items as a planning guide for board activities. This will help ensure that nothing “falls through the cracks” while balancing activities throughout the year.

10. Mix of Routine and Extended Meetings

At least once a year, the board should hold a meeting of extended length to review past year accomplishments conduct a self-review of governance effectiveness and update strategy to chart the way forward for the next year or planning cycle. This type of extended meeting, typically a board retreat, can be followed by a similar extended meeting of key committees – perhaps a month or two following the board retreat – at which committees can assimilate the strategy updates of the board and assess the impacts on committee activities.


Daniel J. Marino, CIN, Clinically Integrated Networks; As President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/ physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at [email protected] or by phone at 312-396-5400.

Topics: Accountable Care, ACO, Accountable Care Organization, Clinical Integration, Clinically Integrated Network, Governance, Daniel J. Marino

What’s In It for Me? Six Compelling Reasons for Systems to Clinically Integrate

Posted by Matthew Smith on Jul 16, 2014 2:42:00 PM
By Daniel J. Marino,
President/CEO,
Health Directions

WIIFM, What's In It For Me?What’s in it for me? That’s a question systems should ask--and answer--before taking on the challenges of forming a clinical integration program or becoming an accountable care organization. Failure to create a shared vision, and an informed commitment to that vision despite all obstacles and concerns, can easily derail change management initiatives down the road. It is important to identify likely concerns and objections, and formally articulate a response to them, early on in the planning process.

Some of the most common concerns we’ve heard from system executives are one or more of the following:

  • Why change at all?  Fee-for-service is still working for us in this market. In fact, our entire business model is predicated upon it. Specifically, the Medicare penalties for excess rates of readmissions-- an early area of focus for many ACOs--are a just a small “cost of doing business” compared to the potential lost revenue from commercial insurers if we really improved in this area.
  • Why change now? We’ve been told before that “the end is near” and that we have to change. Those predictions did not come true then, so why should I believe they’ll come true now? In particular, what happens to ACOs and shared savings-type contracts once all the savings have been wrung out?
  • Can we afford it? How much will it cost, and for how long will we have to subsidize the program? We have a lot of competing demands for dollars.
  • What’s the ROI? Traditional financial models struggle to find a reasonable return on investment. In fact, some show material losses.
  • Do we have to partner with “community” physicians to do this?  Many systems have invested heavily in physician employment. Some are struggling to integrate them or to see demonstrably better quality as a result of these investments. Why spend more now with non-system employed physicians?

Narrow Networks, ACO, Healthcare SystemsHere are some of the more common responses to physician concerns:

  1. Better Care for Patients – The investments the network will make in information technologies, care coordination, performance feedback and other initiatives can drastically improve outcomes for patients. It has been demonstrated by other successful clinical integration programs. The vision statement for most every healthcare system talks to the preeminence of caring for the patient. Clinical integration and accountable care structures allow systems to reach whole new levels of quality, value and care.
  2. Responsive to Market Demands – The sheer number of ACOs--both Medicare and commercial--that have emerged in just the past two years or so is the best evidence that value-based payment arrangements are in demand. More and more insurers are moving to narrow network products too, as employers have become more open to these kinds of models to help rein in their healthcare benefits expense.
  3. Avoid Risks of Non-Participation – A common characteristic of ACO and shared savings-type contract arrangements is that network physicians--or at least primary care physicians--can only be listed in one ACO in the market. Furthermore, commercial insurers are moving more and more into narrow network products that only contract with organized networks of physicians--primary care and specialists. Few systems are able to employ enough physicians to satisfy the network requirements of even the narrowest of these networks. As more and more organizations are forming ACOs, and as narrow networks are increasingly introduced to markets, systems face increasing risk of being “left out in the cold” as markets mature around them.
  4. Upside Payment Potential – Reductions to “unit price” fee schedules by both Medicare and commercial insurers are widely anticipated. Participation in value-based payment models offer systems some opportunity to access additional payment streams from various “value based” contracting forms that are recently or will shortly be emerging.
  5. The Program Can Increase My Business – One of the concerns commonly expressed by system executives is that greater access to primary care services, care coordination and the creation of other efficiencies--typical areas of focus for ACOs--will cut into traditional hospital “profit centers” such as longer than necessary lengths of stay, excessive Level 1 and 2 ER visits, avoidable readmissions, etc. Appropriately designed, there are many ways in which programs can help direct care “in network” to ensure quality and efficiency, enhancing protocols are followed. Furthermore, many healthcare systems are now contracting with their own clinical integration programs for the health benefits of their employees. Savings realized by more efficient care management of system employees and family members can represent a significant offset to other lost or diminished sources of revenue.
  6. Our Prospects Are Better Together – There are those systems that think they could participate as effectively in value based payment models by themselves or with just their employed base of physicians. There are certain areas of value creation that can only be achieved through close working relationship with a broad base of physicians in specialties and geographic locations beyond those in which they have employed physicians.

 Daniel J. Marino, CIN, Clinically Integrated Networks; As President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/ physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at [email protected] or by phone at 312-396-5400.

 FAQ_Button_Orange.png

Topics: Accountable Care, Clinical Integration, Health Directions, Clinically Integrated Networks, Daniel J. Marino, Narrow Networks

New Download: The Data Infrastructure to Deliver Accountable Care

Posted by Matthew Smith on Jul 10, 2014 3:42:00 PM

Data, Accountable Care, ACOIt could be said that data is the fuel and HIT systems are the pipeline for Accountable Care. Building the data infrastructure fo an ACO is a complex undertaking with considerable upfront investment.

Provider organizations must build a strategy, manage their cost structures, and understand the accountable care functions and IT systems that are necessary to make ACOs function properly.

This new PDF presentation from Health Directions examines the process for building the data infrastructure to deliver accountable care, including:

  • The importance of a data-enabled ACO
  • Claims vs. clinical data
  • Why clinical integration is necessary
  • Keys to creating a quality clinical integration infrastructure
  • Basic functions for accountable care
  • Associated IT systems
  • Building vs. buying

Simply click the button, below, to access the download.

 Data Analytics, ACO, Healthcare Data

Topics: Accountable Care, ACO, Healthcare Data, Data Analytics

CMS Proposes Changes For ACOs in 2015; Including Quality Benchmarks

Posted by Matthew Smith on Jul 7, 2014 11:56:00 AM

ACO, Accountable Care Organization, MSSP, Quality MeasuresA new CMS proposal would increase the number of quality measures that accountable care organizations (ACOs) would have to achieve under the Medicare Shared Savings Program (MSSP) in 2015. The changes, which are included in the Medicare physician fee schedule released Thursday, July 3, would introduce 4 additional quality performance benchmarks. ACOs receive bonus payments based on the number of quality targets they meet. The measures would place a greater emphasis on patient outcomes. If adopted in the final rule, the changes would go into effect January 1, 2015.

Specifically, the number of quality measures used to assess ACOs would increase from 33 to 37. ACOs would need to meet the quality performance goals to earn bonus payments under the program. The new measures would include:

  • Whether patients say providers informed them about treatment costs;
  • The rate of patients who are admitted to skilled nursing facilities within 30 days of being discharged from a hospital; and
  • Unplanned readmissions for patients with diabetes, heart failure or more than one chronic condition for any reason.

The proposal to reduce the reporting burden on ACOs and move toward electronic submission of measures is generally seen as a step in the right direction. CMS said it would continue to seek comments over the proposed changes. Officials seek input on future quality measures for care coordination, health outcomes, nursing home quality, prevention, elderly public health, and utilization.  

In addition, CMS proposed:

  • Replacing a measure dealing with medication management;
  • Changing a requirement that ACOs adopt electronic health records; and
  • Eliminating some measures dealing with treatments for coronary artery disease, diabetes and ischemic vascular disease.

According to Modern Healthcare, the changes would bring the measures in line with those used in clinical practices and help simplify reporting.

Also in the proposal, CMS suggested adding new quality incentives for ACOs. The incentives would:

  • Require ACOs to meet certain quality targets while reducing health care spending in order to receive bonus payments; and
  • Allow ACOs to receive awards based on annual quality improvement.

The number of ACO participants, which presently includes 350 organizations, is also expected to increase throughout next year.

MSSP, Medicare Shared Savings Program, ACO, Accountable Care 

Topics: Accountable Care, ACO, MSSP, Accountable Care Organization, Medicare Shared Savings Program

Health Directions Profiled at HFMA's ANI 2014 Conference

Posted by Matthew Smith on Jun 23, 2014 4:11:00 PM

HFMA, ANI, HFMA ANI, Health DirectionsHealth Directions was profiled by HFMA for their ANI pre-conference session, "Second Generation Physician Engagement Techniques." An excerpt of the profile reads:

During a preconference session Sunday at HFMA's ANI: The 2014 HFMA National Institute on Second-Generation Physician Engagement, Daniel J. Marino, President and CEO, and William K. Faber, MD, Chief Medical Officer of Health Directions, concluded that—similar to the findings of HFMA’s Value Project—creating an effective CIN requires several key activities.

  • Health systems need to engage and recruit physicians to the CIN.
  • Systems need to engage payers that will be attracted to the CIN once it has achieved sufficient size and scale as a partner organization that can improve quality.
  • A CIN needs to align incentives for the participating physicians to support activities that lead to improved care outcomes and reduced cost.
  • For the incentives to be effective, physicians need data to not only understand their current performance relative to their incentives but to identify opportunities for care improvement.  Marino and Faber said CINs can build off this infrastructure to negotiate contracts with purchasers of healthcare to support the transition to a value-based delivery system.

To read the full profile of the precon session, please click here.

Click for PDF Flyer of the Session:

http://cdn2.hubspot.net/hub/161605/file-1047595058-pdf/ANI_14_EngagingPhysicians.pdf 

Health Directions will present again at ANI on Wednesday, June 25th with the following session:

The Financial Blueprint of Accountable Care

Date, Time, Location:

Wednesday, June 25, 2014, 11:00 AM – 12:45 PM (Bellini 2006)

Overview:

This session draws from multiple experiences with accountable care and clinical integration as well as direct operational knowledge of building a Pioneer ACO.

After Attending This Session, Participants Will Be Able To:

  • Recognize barriers to building a financially successful clinically integrated network
  • Learn tips and techniques to help transition to value-based care
  • Understand how to align independent physicians with the hospital’s clinical integration objectives
  • Identify methods for building financial incentives

Tools & Takeaways:

Sample incentive model to engage physicians

Speakers:

  • Daniel J. Marino, President/CEO, Health Directions
  • Meredith Duncan, Director of Operations, Seton Health Alliance

Topics: Accountable Care, Clinical Integration, William K. Faber MD, Clinically Integrated Networks, ANI 2014, Meredith Duncan, HFMA, Daniel J. Marino

Health Directions Presenting Two Sessions at HFMA ANI '14

Posted by Matthew Smith on Jun 19, 2014 2:14:00 PM

ANI, HFMA, Health DirectionsThe Healthcare Financial Management Association (HFMA) kicks off their 2014 National Institute Meeting this Sunday in Las Vegas. Running through June 25, ANI 2014 brings together healthcare financial management executives and leaders in finance & accounting, revenue cycle management, and administration/ operations. 

This year's event focuses on eight, central themes:

  • Regulatory Impact on Reform/Rules
  • Clinical Integration/Culture
  • Organizing for Value
  • Revenue Cycle
  • Payment Trends
  • Financi & Operations
  • Cost Management/Margin Transformation

Health Directions is excited to once again be a part of ANI. We have two great sessions planned for ANI attendees. They are:

We invite all ANI attendees to visit the sessions and, if interested, schedule a time to meet with our speakers aside from the sessions. If you would like to schedule a time to meet with one of our speakers, please access a request form via the button, below.

ANI, HFMA, Health Directions, Dan Marino

 _________________________________________________________________

Second Generation Physician Engagement Techniques

Date, Time, Location:

Sunday, June 22, 2014, 8:00 AM – 12:00 PM, (Bellini 2102)

Overview: 

This presentation draws from multiple clinical integration /ACO programs and distills some unique and innovative approaches to engage physicians in achieving distinguished results in the areas of: clinical integration governance; patient engagement; superior clinical results; increased efficiencies; and sustained competitive advantage for the provider organizations.

After Attending This Session, Participants Will Be Able To:

  • Understand and utilize effective approaches to engage physicians
  • Understand how to align the incentives of community physicians within a clinically integrated network
  • Integrate new approaches to build organized systems of care using data

Tools & Takeaways:

Sample incentive model to engage physicians

Speakers:

  • Daniel J. Marino, President/CEO, Health Directions
  • William K. Faber, MD, MHCM, Chief Medical Officer, Health Directions

Click for PDF Flyer:

http://cdn2.hubspot.net/hub/161605/file-1047595058-pdf/ANI_14_EngagingPhysicians.pdf

 _________________________________________________________________

The Financial Blueprint of Accountable Care

Date, Time, Location:

Wednesday, June 25, 2014, 11:00 AM – 12:45 PM (Bellini 2006)

Overview:

This session draws from multiple experiences with accountable care and clinical integration as well as direct operational knowledge of building a Pioneer ACO.

After Attending This Session, Participants Will Be Able To:

  • Recognize barriers to building a financially successful clinically integrated network
  • Learn tips and techniques to help transition to value-based care
  • Understand how to align independent physicians with the hospital’s clinical integration objectives
  • Identify methods for building financial incentives

Tools & Takeaways:

Sample incentive model to engage physicians

Speakers:

  • Daniel J. Marino, President/CEO, Health Directions
  • Meredith Duncan, Director of Operations, Seton Health Alliance

Click for PDF Flyer:

Accountable Care, HFMA, ANI, Health Directions

Topics: Accountable Care, Clinical Integration, William K. Faber MD, ANI 2014, Meredith Duncan, HFMA, Daniel J. Marino

Translating Five Accountable Care Goals Into IT Action

Posted by Matthew Smith on Jun 9, 2014 11:19:00 AM
By Daniel J. Marino, President/CEO, Health Directions

Health IT, HIT, Accountable CareThe push for accountable care has created a new vocabulary for healthcare leaders: clinical integration, longitudinal records, ambulatory networks, patient registries, care protocols, and more. Many hospital CIOs are uncertain how to piece it all together, and they are having trouble pinning down the IT requirements for making accountable care a reality.

The solution is to break the problem down into functional objectives and concrete steps. Following is a quick guide to translating the goals of accountable care into specific action items for CIOs.

Goal #1: Coordinate Patient Care Across Multiple Settings

Coordination is the watchword of accountable care, but from an IT perspective it's often easier said than done. To create the infrastructure for coordinated care, hospital CIOs should focus on three steps.

First, select a platform for exchange that ensures interoperability. True system interoperability takes disparate medical data maintained in different formats and transforms it into integrated multidisciplinary patient care information. Many large healthcare organizations are faced with the challenge of connecting 100 to 400 different information systems, including both internal systems and those of community partners. The key is exchanging patient information in a continuity of care record (CCR) or continuity of care document (CCD) format, aggregating the data from major clinical systems and semantically organizing it into viable medical information for providers.

Second, establish an agnostic application strategy. Individual clinical systems need to interface with other applications, but “integrated” enterprise solutions also pose a challenge. An integrated hospital/ambulatory solution has many benefits and will make implementation easier, but some vendors discourage connecting outside the integrated platform. This will undermine coordination of care and true interoperability. CIOs need to select an integrated solution that allows full connectivity-or specify within the vendor agreement that outside interfaces will be allowed and supported.

Third, connect to or build a health information exchange (HIE). Several options are available. The critical question for IT executives is: what is your hospital's strategy? Does the hospital intend to lead its own ACO, develop clinical integration, and drive decisions about data collection and sharing? If so, you probably need to develop your own HIE. If, on the other hand, your hospital plans to take part in a community accountable care strategy, consider connecting to your state or regional HIE.

Goal #2: Improve Quality & Outcomes

The opportunity is clear-using electronic medical record (EMR) technology to push evidence-based care and quality improvement. The challenge is that there is no cookie-cutter approach. Again, three action items are key.

First, focus on “tailoring” structured data. Where will hemoglobin A1c labs for diabetic patients appear within the EMR? How will consult notes map into the system? While many EMR systems are pre-loaded with structured data, “out of the box” data sets rarely work well. CIOs need to make sure structured data are individualized to the organization's clinical goals.

Second, build a patient longitudinal record. To manage quality, physicians need a composite patient record within the ambulatory EMR. Customization is essential. Work with physician leaders to make sure patient information is mapped to the right place within the EMR. (This will often be determined by physician workflows.) Also, work with clinicians to standardize terminology for tests, lab values, diagnoses, etc. This is critical to ensuring the system has useful semantic data.

Third, implement clinical decision support systems (CDSS). Technology can drive better care through automated alerts and reminders. Once more, however, avoid prepackaged solutions. CDSS functions need to support the specific clinical quality and improvement goals of your organization.

Goal #3: Reduce Costs & Utilization

The government has already decided how much money it will save thanks to accountable care. Whether hospitals will maintain profitability depends on their ability to manage costs. The job of the CIO right now is to build the IT infrastructure for identifying “cost of care,” quality-of-care thresholds, and revenue metrics. The important thing to realize is that traditional business information systems are not up to this task.

Guidance on Strategies, Systems, Priorities, and Pitfalls for Hospital CIOs

Instead, put resources into creating or enhancing a data warehouse system. The goal is to be able to integrate system-wide cost, utilization, and revenue data and stage it for reporting. Hospital IT also needs to acquire or develop advanced analytics capabilities. Look for a system versatile enough to tie clinical outcomes to revenue cycle claims data.

Functionally, the goal of a data warehouse/analytics system is to identify opportunities to reduce waste, reduce spending, and improve operational efficiency.

Goal #4: Integrate Patients Into Communication

There are a growing number of personal health record (PHR) systems on the market. Most hospitals are looking at ways to use these systems to provide patients with access to their health data. But under accountable care, patient integration is about more than just information access. IT executives need to focus on using PHR systems to build patient engagement and support chronic care.

One priority is technical. Make sure PHR data feeds into key information systems, including the hospital registration system, the acute care EMR, and the ambulatory EMR. The second priority is strategic. CIOs need to guide PHR design based on high-level decisions about what information will be captured and exchanged and how it will be used. The overall driver is strategy. For example, if a hospital is launching its accountable care effort with a clinical integration project for asthma management, the IT department should configure the PHR to allow patients to log their medication use, record lung function measures, and receive seasonal asthma reminders.

Goal #5: Create Managed Clinical Value

Right now, accountable care is being driven by the promise of higher government payments. Before long, however, leading accountable care organizations will work proactively to identify enhanced clinical value and get paid for it.

Here, the most precious commodity is patient medical information. What many hospital leaders struggle with is that an EMR system is not enough. EMR is a tool for capturing and retrieving patient information at the point of service. For CIOs, the core action item is to build a model of system integration that allows for the capture of clinical data within a data repository.

A clinical data repository (also called a patient disease registry) is a database that stores and coordinates clinical information for an entire population of patients. It allows an organization to report off clinical data, which is needed for calculating actual clinical quality outcomes and comparing them against industry benchmarks. By tracking clinical quality outcomes and accurately measuring the cost of care, hospitals will be in a position to identify savings-which will then lead to evidence-based reimbursement opportunities. A clinical data repository also creates an infrastructure for joint clinical decision making about population care. This is essential for achieving clinical improvement across the enterprise to meet performance goals and therefore payment goals.

Hospital Strategy is Key

The common theme that runs through all these action items is the importance of an integrated IT strategy. The key to designing an effective IT infrastructure is to focus on your hospital's clinical and business goals. In almost every case, strategic goals determine how to configure technology to support accountable care.

ACO, Accountable Care, Clinical Integration, Population Health

Topics: Accountable Care, CIO, HIT, Health IT, ACA

Infographic: The Game of ACO

Posted by Matthew Smith on May 30, 2014 9:48:00 AM

ACO, Accountable Care OrganizationCreated by the National Council for Behavioral Health, this fun infographic spells out the steps for becoming an Accountable Care Organization (ACO). While the intended audience is for behavioral health providers, this infographic serves as a great way to break down the process for any provider to be a part of an ACO. Through a four-step process, designed to look like Milton Bradley's "The Game of Life" game board, the infographic visually ties in the preparation, IT readiness, and implementation necessary for ACO participation.

To download a full-size image of this infographic, click here and right-click on the image to save to your device.

To view a larger version of this infographic on your screen, click here and then click the image again to expand.

Accountable Care Organizations, ACO, Infographic

 

MSSP, Medicare Shared Savings Program, ACO, Accountable Care

Topics: Accountable Care, ACO, MSSP, Accountable Care Organization, Behavioral Health, ACO Participation

12 Trends on the ACO Frontier

Posted by Matthew Smith on May 9, 2014 11:36:00 AM

ACO, Accountable Care, Health DirectionsThe accountable care organization (ACO) movement continues to heat up. In fact, looking ahead, there is a greater number of ACOs in the wings than one year ago.

Forty-four percent of developing ACOs will be helmed by physician-hospital organizations, according to a new infographic from the Healthcare Intelligence Network.

This HINfographic examines 12 emerging ACO trends at 138 healthcare organizations and delivers tactics from a top performing Pioneer ACO, Monarch HealthCare.

Infographic source: Healthcare Intelligence Network

ACO, Accountable Care Organization, Health Directions, Infographic

MSSP, Medicare Shared Savings Program, ACO, Accountable Care

Topics: Accountable Care, ACO, Accountable Care Organizations, Pioneer ACO, PHO

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