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ACO Success Needs Robust Health IT

Published December 11, 2015 8:53 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Jonathan Draper]

Coordinated Care Model

In early 2015, the Centers for Medicare and Medicaid Services (CMS) announced that 50% of payments will be made through alternative or value-based payment models by 2018. One way for providers to implement value-based care is through an Accountable Care Organization, or ACO, a coordinated care model initiated by the Affordable Care Act in 2010. ACOs are networks of providers, including primary care, specialty practices, hospitals, pharmacies, imaging and diagnostic centers, that come together to lower costs and deliver better care through care coordination.

The key motivation behind the ACO movement are financial incentives based on ACOs achieving both lower costs and improved quality. Experience with the ACO model has also shown that a key consideration in the success of ACOs is the ability to share and exchange patient health information.

Image Sharing Critical to Patient Care and Profitability
Sharing images, lab results and other patient data among physicians is critical for two reasons. First, it lowers costs by eliminating redundant imaging and testing. Secondly, ACOs allow patients to get care wherever they like so the ability to share information across institutions becomes a central component of coordinating patient care. Patients can use any hospital or specialist, but the primary care provider and his or her ACO is still responsible for the costs associated with those visits. Providers now have a clear incentive for tracking where patients go for care and why. To do this, they need access to an underlying health IT infrastructure that supports patient sharing and exchange.

As they seek to share and access patient with disparate organizations and systems in order to stay in step with their patients, ACOs have become more aware of barriers to data exchange. A 2015 survey by the Workgroup for Electronic Data Interchange found that most ACOs do not have tools for either sending or receiving complete patient health data in a simple and timely manner.1

Some ACOs are made up of participating groups that each their own electronic health record, for example. For these ACOs, sharing data and images to manage and coordinate care among isn’t just nice to have, it’s essential to their ultimate profitability. Images play a critical role in this information exchange. First, by sharing them ACOs save the cost of redundant imaging. Also images are critical to patient care, particularly in emergency situations. Sharing both images and other patient information is the key to ACO profitability.

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posted by Silas Gossman


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