Accountable Care Is about Connecting with Patients

Last week, I spent some time with the folks at Partners Healthcare and my industry peers at the Partners Connected Health Symposia. The event was a great way for health IT professionals to see how and why we need to continue to develop innovative solutions in information technology to connect patients to improve their healthcare.

When I was at the meeting, the Centers for Medicare & Medicare Services (CMS) issued, on Oct. 20, 2011, the Final Regulations or the Medicare Shared Savings Program (MSSP), which govern the creation of accountable care organizations or ACOs.

• An ACO is defined as an organization of healthcare providers that jointly offer services with a goal of cost reduction and quality patient care improvement.
• This organization of providers may enter into an agreement with HHS for a three-year minimum agreement period.

An ACO will focus on achieving what is called the “triple aim:”

• Better care for individuals;
• Better health for populations; and
• Lower growth in expenditures.

The need to manage data across the continuum of care in ACOs will be critical to their success in reaching the triple aim.

1. The health IT sector will have to support the need of ACOs for clinical and business intelligence.
2. Information technology will assist ACOs to interact in real-time as well as link EHR information with payment systems for care coordination and overall population management.
3. Health information technology will be the linchpin to efficiently support the quality reporting metrics for an ACO in support of achieving the triple aim of providing better care and health for populations that will support overall reductions in healthcare costs. 

CMS made several changes in the rule base upon industry feedback. Key areas of the rule to note are:

• Two payment models within the ACO program from the start, including an option that does not involve downside risk during the initial three-year agreement period.
• A limited shared savings split of up to 50 percent in the one-sided model and up to 60 percent in the two-sided model, but share on first dollar for all ACOs in both models after meeting the minimum savings rate.
• Elimination of CMS’ proposal to withhold 25 percent of the shared savings to account for potential losses.
• Elimination of CMS’ initial requirement that at least 50 percent of all primary care physicians in the ACO must be considered meaningful users of electronic health records to participate in the program.
• Adoption of 33 individual measures of quality performance – down from the proposed 65 measures – that will be used to determine if an ACO qualifies for shared savings; as in the proposed rule, performance standards for the first year are met by satisfactory reporting.
•  Availability each quarter of aggregate Medicare Parts A, B and D data, and in response to a formal request from an ACO, CMS will provide beneficiary-level claims data as frequently as on a monthly basis.

ACOs must have a data user agreement (DUA) in place before obtaining beneficiary-level data. CMS will provide quarterly reports, and although not defined, it appears that report data set requirement is an expansion from the draft rules.

The final rule will be published in the Nov. 2 in the Federal Register. HIMSS continues to monitor ACO development and utilization and its impact on HIMSS’ members.

For more information, visit the HIMSS website with its new resources to help you understand the changes and implications of the final ACO rule.

You can also contact me, Mary Griskewicz, Senior Director Health Information Systems, at mgriskewicz@himss.org.