Accountable Care Organization
Since its inception in 2009 as a key piece of the Affordable Care Act, the goals of the accountable care organization (ACO) have been clear: provide timely, coordinated care; manage at-risk populations; and eliminate redundancy across the continuum. But while the goals may be straightforward, the best ways to implement an ACO are not.
Successful ACOs are the result of strategic planning, organizational efficiency, and a robust IT infrastructure that supports the ACO’s daily operation. Since the aforementioned goals depend on timely and accurate data, having the right IT infrastructure is essential. Organizations that have invested heavily in their EHR platform(s) to support these new initiatives are only now discovering that a comprehensive ACO portfolio may require functionality and solutions that aren’t available in all EHR products.
Is the EHR Enough?
To take advantage of the growing popularity of ACOs, many EHR vendors have built modules that contribute to providing accountable care: care coordination tools, patient portals, secure messaging, finance and accounting systems, analytics platforms, and risk-based patient management. But a recent report on ACOs published by KLAS revealed that while some EHR platforms act as a “one-stop shop” and cover all ACO requirements, others may have some weaknesses in critical areas. For example, an EHR-based ACO platform may have robust analytics capabilities but lack the strong patient engagement tools necessary to reach specific patient populations. Report author Erik Burmudez noted that “with very few exceptions, EHRs are not meeting all ACO needs, causing many third-party products to be invited to the ACO discussion.” In order to build the most efficient ACO, organizations must review the capabilities of their EHR and support modules, and then determine whether identified weaknesses can be addressed by other third-party applications.
While EHR vendors had early-mover advantage, third-party suppliers with more narrowly defined and specific solutions are now launching their own platforms for quality and patient-centric care. These solutions can be used to supplement EHR capabilities where needed. Some of these independent solutions may target patients with chronic conditions or offer prevention tools to pre-chronic patients. Other independent products might offer a feedback loop so that providers and their patients can communicate openly about progress and coordinate future care.
The graphic below illustrates how third-party modules can supplement an EHR. In this example, the EHR platform (in green) has functionality to meet some of the goals of an ACO, while third-party vendors (in red) are bridging the gaps to ensure a complete ACO IT portfolio. These niche applications are not intended to be as robust as the platforms EHR vendors are providing, but they can augment what is already in place and/or provide a better solution for a particular functionality. Leveraging these third-party modules to complement your EHR functionality and complete your core IT infrastructure is one of the keys to achieving the aforementioned ACO goals.
Strategy: Moving From a Single System to a Portfolio
While the optimal path for supporting an ACO from a technology perspective is not always clear, the variety of vendor offerings enables organizations to build their own ACO IT portfolio. The enterprise EHR may no longer be a self-contained solution for meeting the needs of HCIT initiatives, so organizations need to consider moving from a sole-source strategy to a portfolio model. Regardless of the modules’ origin and how they are combined, a complete IT portfolio is required to execute and track the quality initiatives of an ACO. This will not only ensure a technically sound ACO approach, but also allow the organization to optimize care across patient populations.
Carson Marston, Senior Consultant, contributed to this post.