It is difficult to dispute the successes experienced by early adopters of the accountable care organization (ACO) model. Even some of the most vocal skeptics are acknowledging the tremendous benefits of the associated cost savings and delivery of quality patient care. There is, however, a growing recognition that participating in an ACO is a daunting task that requires a significant investment in time and resources, as well as a commitment to cultural change. With constant demands and commitment to other programs, such as meaningful use (MU) and patient-centered medical home (PCMH), organizations may feel they simply cannot take on another massive endeavor. Yet despite their misgivings, many of those organizations are actually much closer to ACO participation than they realize.
By successfully implementing and using an EHR, organizations participating in MU have already laid the foundation for accountable care. An EHR’s ability to capture standard patient demographics for reporting, electronically prescribe medications, order labs, and share clinical data with other systems is fundamental to ACO participation. Further, many of the measures that organizations currently monitor and maintain can be repurposed for ACO participation. These include health promotion education, secure communication with providers, and patient access to medical records for MU Stages 1 and 2. Additionally, MU Stage 3 promises to build on current objectives with an emphasis on patient engagement and clinical quality performance – functionality that clearly aligns with the objectives of an ACO.
ACO participation is also within reach for organizations that have achieved PCMH designation. In becoming a PCMH, an organization has demonstrated success in transforming its culture to support streamlined, quality care and an optimal healthcare experience for patients. Educated and devoted staff utilize IT and redesigned work flows to effectively capture and report quality measures concerning cancer screenings and management of conditions such as diabetes and heart disease by monitoring labs and medication regimes. Several of the PCMH quality measures are identical to the National Quality Forum (NQF) requirements for ACOs. While PCMH designation is not necessary for ACO participation, organizations that have achieved such recognition have thus already fulfilled several ACO requirements.
The diagram below illustrates the corresponding relationship for select ACO measures that organizations may already be capturing.
Over 60% of ACO measures directly correspond to measures achieved as part of MU or PCMH. In addition, some objectives are common to all three programs, including tobacco cessation, BMI management, depression screening and counseling, and adherence to vaccination schedules.
The process of becoming an ACO may appear resource-intensive and logistically complex, but take the time to connect the dots. You will soon realize that ongoing efforts centered on MU and PCMH have given your organization a significant head start.