Page 58 - 2013 Hospitals/Systems Digest US.NMH.13.02.007
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HOSPITALS/SYSTEMS DIGEST 2013
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
LOOKING FORWARD
Among the accountable care organizations
(ACOs) currently being formed—both those
participating in official demonstration pilots and
those operating independently—a small number
of disease-specific ACOs have been established.
These organizations target populations with
the costliest chronic conditions, such as cancer
or end-stage renal disease, in an effort to
standardize, streamline and improve treatment—
and eventually lower costs—for these patients.
ACOs that target patient populations with a
specific diagnosis may become more numerous,
depending on the success of these early models.
The payoff for success at these ACOs could be
extensive—bringing considerable savings by
targeting conditions that are most costly
for Medicare and other payers (in 2010, Medicare
outlays for end-stage renal disease, for example,
were $32.9 billion, or 6% of total expenditures),
refining treatments and improving overall patient
health among these populations. Rather than
establishing screening goals for patients, these
ACOs may set treatment guidelines and objectives
to standardize efficient patterns of care.
1
Although well established primary care—crucial
to managing patient health—is the focus of the
majority of ACOs, disease-specific models will also
have to balance primary with specialty care in
order to provide the best outcomes. If effective,
disease-specific ACOs could become the catalyst
for future care models devoted to reducing the
financial impact of chronic diseases.
Disease-Specific ACOs Test Efficiencies for Managing Patients
LOOKING FORWARD
1
Elliott, V. S. (2013). Disease-Specific ACOs Make Their Debut. Retrieved from
2
Centers for Medicare and Medicaid Services. (2012). EHR Incentive Program. Retrieved from
3
Jamoom, E., et. al. (2011). Physician Adoption of Electronic Health Record Systems: United States, 2011. Retrieved from
The coordinated care models highlighted
under the Affordable Care Act (ACA), such as
patient-centered medical homes (PCMHs) and
ACOs, rely not only on open communication
between providers and patients in various settings,
but also require a robust healthcare information
technology (HIT) infrastructure. This technology
will be necessary to reliably—and confidentially—
allow for sharing of patient-level health care
data, a necessary component of modern care
coordination efforts.
Even before the ACA was signed into law, the
federal government was already investing in HIT,
using funds from the American Recovery and
Reinvestment Act (ARRA) to encourage physicians
to boost their use of electronic health records
(EHR). Participating providers that demonstrate
meaningful use of EHR technology can receive
up to $44,000 for each participating year through
the Medicare EHR Incentive Program, or up to
$63,750 for the Medicaid EHR Incentive program.
2
Meanwhile, hospitals—but not physicians—may
take part in both programs, if they operate in a
state participating in the Medicaid program.
The ACA continues the work of the ARRA
by including the percentage of physicians
participating in the EHR Incentive Program
among the 33 quality measures ACOs must meet
in order to qualify for shared savings. Furthermore,
one PCMH-oriented demonstration project (see
page 50) requires that participants be recognized
as Level 3 PCMHs by the National Committee for
Quality Assurance (NCQA), a designation that
comes with minimum EHR standards.
Adoption of EHR remains far from universal. As of
2011, one study showed that 54% of physicians had
adopted an EHR system. This percentage rose to
86% for medical groups with 11 or more physicians,
3
a statistic that may indicate that size barriers still
prohibit the implementation of such technologies.
In addition to the cost, other impediments to
universal adoption exist: standardization and
compatibilities of disparate systems, for example,
plus caregiver and patient training in the use of
these systems. Despite these obstacles, the need
for widespread EHR use persists, especially as part of
quality improvement and care coordination efforts.
EHRs Expected to Play a Continued Role in Care Coordination
