Health information technology and its meaningful use will glue together many of the key elements of accountable care as the Centers for Medicare and Medicaid Services described it in its long-awaited proposed rule. Health IT will play a critical role in the establishment of accountable care models, according to industry experts.
CMS’ Medicare Shared Savings Program establishes the framework for accountable care organizations, a team-based approach to health care called for in the health reform law in which providers are jointly responsible for a patient’s care and jointly share in the financial savings.
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“CMS wisely recognizes the essential role of electronic health records (EHRs) for accountable care success, for example, in proposing that 50 percent of the primary care providers in an ACO must be meaningful EHR users by the start of the second year of the shared savings program,” Mark Segal, vice president for government and industry affairs for GE Healthcare Information Technology, told Government Health IT.
Accountable care organizations (ACOs) are designed to improve population health, enhance individual patient care quality and reduce costs, according to Dr. Don Berwick, CMS administrator. The program launches Jan. 1, 2012.
“An ACO will be rewarded for providing better care and investing in the health and lives of patients,” he said March 31 in announcing the proposed rule. CMS will publish it in the Federal Register on April 7, after which the public may comment on it until June 6.
ACOs create incentives for providers to work together to treat Medicare patients across care settings, including physician offices, hospitals, and long-term and rehab facilities, coordinate their care and apply standards to improve their performance.
Healthcare providers will need the capabilities of electronic health records, health information exchanges and other tools so they can share patients’ data wherever they seek treatment, distribute decision support about treatment and communicate securely to coordinate patient care.
“As existing and new organizations with disparate health IT systems and provider organizations create partnerships that enable coordinated care, health information exchange solutions will play a pivotal role in breaking down today’s information silos,” Segal said.
[Related: CMS has paid out $37.6 million in EHR incentives so far.]
Providers in these new care models will also need robust analytical tools to gain insight from that information “in order to make better decisions and eliminate inefficiencies in today’s healthcare delivery systems,” he said.
Among its provisions, the proposed rule lists 65 quality measures that provider teams need to meet to prove their quality performance across five domains--patient safety, care coordination, prevention, patient and caregiver experience, and at-risk populations.
Many of the quality measures overlap with those in existing CMS efforts, such as for the meaningful use of EHRs in CMS’ EHR Incentive Program, the Physician Quality Reporting System and the Hospital Inpatient Quality Reporting Program, according to the agency’s explanation of the proposed rule.
CMS said it would continue to align ACO quality measures with those for meaningful use.
The agency will accept applications for a number of pilots to test primary care models that put the concepts of accountable care into practice in a variety of clinical settings across the country.
