Top 10 Questions to Ask While Assessing Information Solutions for Clinical Integration and Accountable Care Organizations
Federal and state government incentives for physicians and hospitals to install and meet “meaningful use” requirements for information technology (“IT”) have created an unrelenting push to implement electronic medical records. While meeting government guidelines is important, senior management leaders need to remember that to make healthcare systems more effective and efficient, these strategies must deliver better tools for caregivers. Any of the strategies being employed to improve the quality of healthcare and reduce costs require the ability to manage, interpret, and coordinate information in real-time. The tenets of pay-for-performance programs, medical home models, clinical integration (“CI”), and accountable care organizations (“ACOs”) are based on improving care delivery through coordination of the entire continuum of care. Here are the top ten questions senior leadership should discuss in preparation for this “new world.”
1. Why should we consider CI or becoming an ACO? CI has demonstrated results in improving quality and reducing costs – key goals to achieve in the path toward accountable care. Organizations that meet the Federal Trade Commission’s (“FTC”) definition of CI achieve efficiencies by monitoring and controlling quality, service, and costs, selectively choosing physician participants, and making a significant investment of monetary or human capital in infrastructure. An additional benefit for organized groups of independent physicians that become clinically integrated is that if these groups meet FTC guidelines, they will be allowed to jointly contract with payers. In many markets, a majority of physicians are not in an employed group model; the CI structure allows them to provide better patient care as well as be rewarded by increasing the quality, service, and cost effectiveness of the care. Ultimately, CI is an early stepping stone to becoming an ACO.
2. What are the keys to a successful information strategy for CI and ACOs? Regardless of the organizational model (e.g., large multi-specialty group, IPA, PHO, or integrated delivery system), the information system should lead to higher quality, effective, and efficient patient care. The system must provide the right information, at the right time, in the right form and be supported by an infrastructure to assure its security, maintenance, and use. Providers must be able to make timely, personalized decisions for the individual patient at the point of care. These decisions must be based on current, comprehensive information and patient history.
3. How will this information strategy improve the quality of healthcare, reduce costs, and provide the ability to manage, interpret, and coordinate information in real-time? Real advantages and productivity gains are realized only if the caregivers have access to real-time information at the bedside, exam table, or through secure email exchanges between providers, staff, and patients. Physicians and caregivers should easily be able to collect, visualize, and interpret information and compare it to network protocols, guidelines, and databases when it counts – that is, at the time of decisions. The information strategy must avoid locking information into inaccessible “islands.”
4. Does the proposed strategy facilitate working toward the goals of quality, service, and cost reductions implicit in the new payment incentives? Payment incentives rely on the ability of an organization to demonstrate and document care processes and the achievement of performance targets, including clinical and patient satisfaction metrics. Some of these requirements can be met with relatively simple IT solutions, but more sophisticated and comprehensive systems are needed to drive improvements throughout the continuum of care. The IT strategy must focus resources on assisting the caregiver in knowing not only what to do, but when to do it (i.e., real time alerts). It must also indicate if their performance is getting better or worse.
5. How can we incorporate independent physicians and small medical groups in CI? Using CI tools, even small to mid-sized physician groups, in partnership with an IPA, PHO, hospital, or integrated delivery system, can use information technology to begin to impact the health status of their patients, meet the requirements of payers, and identify process improvement opportunities.
6. Does the technical infrastructure of this information strategy meet the requirements set by the FTC? The technical infrastructure for CI must address two key components to meet the FTC definitions: “the use of common information technology to ensure exchange of all relevant patient data” and “the development and adoption of clinical protocols.” The exchange of all relevant patient data requires a platform that can integrate data from multiple community sources (e.g., hospitals, physician offices, labs,) and store this data in a central data repository. This immediate availability of trusted data is the key to patient care collaboration, the identification of diseases and corresponding care protocols, and performance monitoring at the provider, practice, and network levels. The assembly of patient data from multiple sources requires careful consideration to ensure accuracy and completeness.
7. Does this strategy facilitate the integration of existing systems across the provider and service continuum? Integration of existing systems across the provider and service continuum must be considered when designing a CI infrastructure. Regional health information exchanges, hospital enterprise systems, electronic medical records, ancillary provider portals, and patient portals can all potentially be leveraged as part of the overall solution. These solutions must be evaluated carefully as they alone will not guarantee that CI has, or will be, achieved. Regardless of the solution chosen, at least one should be available to virtually every physician. As the tools become more comprehensive, the ability to drive results increases dramatically.
8. Do the information tools meet the criteria and requirements in order to be successful in CI and accountable care? To meet the functional needs related to the exchange of patient data, the technical support for CI must meet the following:
■ Provides immediately available clinical results to be viewed across service providers
■ Provides access to the established clinical guidelines
■ Provides a secure mechanism for provider communication
■ Allows providers to assign patient access to referring or consulting providers
■ Provides access to protocol adherence and measure quality outcomes at the provider, practice, and network level
■ Allows electronic prescribing
■ Enables clinical decision support based on network determined guidelines including point of care alerts
■ Tracks physician performance against benchmarks and their peers
9. What are the resources required and timelines for implementing an information strategy for CI and ACOs?
There are various methods to approaching the development of a successful long-term information strategy for CI and ACOs. An evaluation of a build vs. buy scenario will determine the best approach with the greatest potential for success and, in many cases, a combination of the two will be the final solution. Factors that may play into the decision include current internal resources, expertise, and internal systems, current vendor applications already in contract, vendor experience and satisfaction, desired timing of implementation, and cost. There are pros and cons to each approach which can be generalized, but individual organizations should pay careful attention to the internal IT culture and history of IT implementations before choosing an approach.
10. How will we know when the changes in information strategy have led to the desired outcomes for quality and efficiency, and how should we continue to support these ideas and capabilities? The only way to be aware of successes or failures is to measure them! When information is organized into a structured system, the focus must be on meeting the needs of physicians, providers, and patients’ care while decreasing errors, gaps, delays, and variation in practice. What are the users’ satisfaction levels with the content, its ease of use, and its relevance to meeting their needs? The strategy should create a highly flexible integrated system with tools that help each patient/member become healthier, leading to a healthier population while focusing on impacting cost, efficiency, and quality. As with all work, it is never complete and will lead to the next iteration as the bar is raised.
For more information on clinical integration and accountable care organizations, please contact Jim Smith at 800.360.0603 x6108 or jsmith@thecamdengroup.com or Claire Heideman at 312-775-1703 or cheideman@thecamdengroup.com.