By Daniel J. Marino, President & CEO, Health Directions
Part 2 of a 3-Part Series
Taken together, the demand for cost control and quality improvement, trends in new technology, and developments in the payer landscape are pointing toward five functional requirements of an accountable care IT infrastructure. To support an accountable care enterprise, IT systems must enable providers and administrative leaders to:
- Coordinate patient care across multiple settings.Experts believe the lack of coordination between caregivers is responsible for a large portion of excessive costs. Poorly coordinated care leads to redundant services (such as duplicative diagnostics), medical errors (leading to additional costs) and poor overall care for patients with chronic conditions. The IT infrastructure for an accountable care initiative will need to enable strong coordination of services via information sharing between primary care physicians, specialists, hospital-based caregivers (including the emergency department), diagnostic facilities/departments, laboratories and others.
- Systematically improve quality and patient outcomes. There are many opportunities to improve patient care by adhering to existing evidence-based guidelines. Additional gains can be achieved by improving efficiency and implementing systems to measure, track and improve quality and outcomes. Accountable care IT systems will support providers by capturing structured clinical data, helping them adopt evidence-based medicine and incorporating clinical care plans to enable provider organizations to manage quality data for entire patient populations.
- Systematically reduce costs and utilization. As with clinical improvement, gains in cost control and efficiency can be achieved by reducing redundant processes and using data analysis to identify savings opportunities. The IT infrastructure for an accountable care initiative will support adherence to efficient clinical and administrative processes and enable financial leaders to use data to identify the cost of care and improve financial performance.
- Incorporate patients in the information loop. Patient compliance is a major obstacle to effectively managing the cost of chronic disease and improving clinical outcomes. Effective IT systems will support accountable care efforts by enhancing patient communication, engagement and monitoring. For instance, clinical outcome tracking around chronic disease management will enable organizations to create patient-focused clinical outreach programs designed to encourage patient compliance.
- Identify and enhance managed clinical value. First-generation accountable care initiatives are concentrating on securing additional revenue from government and commercial shared savings programs. Second-generation initiatives will work to tie clinical outcomes to the cost of delivery of care with the goal of negotiating performance-based managed care contracts. To support this goal, accountable care IT systems must develop increasingly powerful capabilities for storing, mapping and analyzing clinical and claims data from the entire range of clinical and administrative systems.
Hospital CIOs can significantly narrow the scope of IT planning by focusing on the five functional requirements of an accountable care infrastructure. However, these functional objectives do not answer every question about IT design. CIOs still have the challenge of creating an infrastructure that supports the hospital’s specific goals and tactics. The ultimate decision parameter in the IT development process is the hospital’s unique accountable care strategy.
Basic questions include:
- Will your organization lead an accountable care enterprise or participate in someone else’s? The answer will determine how you manage connectivity and create data management capabilities.
- Which other entities will the accountable care enterprise interact with and how? The further the network reaches, the greater attention you will have to pay to interoperability issues.
- What is the hospital’s model for collaborating with physicians? Depending on whether providers are organizing as an integrated delivery network (IDN), a physician-hospital organization (PHO), an independent practice association (IPA) or some other structure, you will need to take a different approach to coordinating EMR systems. This decision will also drive an organization’s hospital and physician integration strategy.
- What governance model is in place to help drive decision making? Since working toward accountable care requires building on defined strategies, a strong physician-hospital leadership governance model is critical to providing direction and support for IT decisions.
The CIO’s job is to build an IT infrastructure that delivers core functionalities in a way that supports the hospital’s accountable care strategy with regard to physicians, other provider entities, payers and the market. The key to creating an IT system that delivers on hospital strategy is to understand the different components of an accountable care infrastructure.