Today my publisher announced release of The ACO Survival Guide: First Edition. It has been a work of earnest effort as I dove into the depths of ACO regulations and emerge with valuable and useful information for Accountable Care Organizations with insights on the move from fee-for-service to pay-for-performance and accountability.
We are in an era of challenging healthcare transformation with the goals of better care for individuals, better population health, and lower costs. ACO legislation was enacted by the Affordable Care Act that provided CMS with the opportunity to enter into agreements with voluntary Physician Groups that care for Medicare beneficiaries.
So, today is the release of the 1st product but the work doesn't stop here. I am once again in the depths of regulations working on a training video that describes the calculations and metrics that shape how Accountable Care Organizations can share in savings provided to Medicare on the One-Sided or Two-Sided Tracks.
More to come!
Link: Modern Healthcare
The Affordable Care Act (ACA) authorized the Secretary of the Department of Health and Human Services (HHS) to enter into agreements with Accountable Care Organizations (ACOs) on a shared savings basis with the goals of improved health outcomes and efficiency. Medicare Shared Savings Program (MSSP) ACOs are measured on the quality of the patient experience, preventive care and disease management and some of the leading causes of death among U.S. elderly.
In September 2014, Modern Healthcare reported that CMS released results of each ACOs’ financial performance. Of the approximately 200 ACOs, 53 reduced the cost of patient care enough to share $300 million in bonuses. These results are a significant development in Medicare cost reduction. A link to the PDF is here.
In order to monitor quality measures and metrics to achieve these goals, investment in infrastructure and redesigned care processes may have been used to monitor care provided to Medicare beneficiaries. Infrastructure might include a data warehouse that syncs data from EMRs to provide monitoring capabilities for performance standards and metrics. A data warehouse model might look like the picture below, where the ACO gathers data from a variety of sources to monitor and benchmark performance.
a. Performance Standards
b. Quality Metrics
c. Analytics and Big Data
Health Informatics includes resources and methods to manage health information and the tools and infrastructure to analyze data. Analytical tools may come in the form of EHRs, data exchanges, data warehouses, database repositories, paper documents, networks and protected internet access.
Due to the nature of data collected by ACOs and the need to share data among providers, there can be significant challenges. Some of these challenges come in the form of "Big Data."
Big data essentially implies a database schema that is suitable for answering queries that may or may not have been anticipated at the time of schema design.
One of the challenges in a big data implementation is recognizing that numerous design considerations are far different than what normally apply to a transaction system.
Big data implies much more than data warehousing.
Part 2 touches on the hidden costs of Healthcare Information Technology (HIT) and drivers for improving quality of patient care.
The largest investment in Healthcare technology goes beyond installation and to the training and use of these systems. Training is often a hidden cost which impacts perspective on Total Cost of Ownership that may, in fact, be one of the largest costs.
Keep in mind that from a clinical perspective, one of the most important benefits of HIT is to reduce inefficiencies and improve the quality of care. So, there are some costs savings to be realized when the technology is used accurately.
Improving the quality of patient care is a major goal for healthcare, across all disciplines, driven by the National Quality Strategy (among others) for adoption of quality and compliance measures to monitor quality of care. Compliance with these aims can be monitored in the aggregate or at a patient level in most CDS systems.
The National Quality Strategy is driving change in healthcare to improve quality. The 3 aims of the National Quality Strategy are:
Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
Healthy People and Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.
But a new twist on the value of Clinical Data available for "mining" and "drilling" are "databases of clinical information" that can be used for medical research.
Given this opportunity, some costs associated with traditional Clinical Trials may be mitigated by using information obtained from an EMR and Clinical Decision Support system (CDS).
Using this technology, data can be massaged and analyzed in a manner that provides retrospective views of medical data for research. These technologies become enablers for Medical Research and Clinical Decision Support Analysis.
"A recently released report by Ewing Marion Kauffman Foundation proves the value of big data is certainly something to take seriously. And as more organizations create plans to make better use of and leverage their big data, Joe Petro, senior vice president of healthcare research and development at Nuance Communications, believes the industry is on the brink of seeing some pretty remarkable things as a result."
Link to article above.
Recently the ONC posted on the Health IT Buzz Blog about the "challenges providers face in achieving Meaningful Use of electronic health records (EHRs)."
The concept of "useability" has long been known in other industries where new technology or applications enter the workplace. Some time ago I wrote about usability of health IT, however I expanded the definition to include a few more "E-bilities" as shown in the following graphic contained in the post: Part 4 of The Value of the Internet for Improving Healthcare.
This is the last post in the series and it focuses on capabilities, or "e-bilities" of technology to improve healthcare. Regardless of the mode of use (e.g. email or internet), technology must be easy to use, secure, reliable, and accessible.
For the past year, the SHARPC-Project 1 has focused on making use of technology easier for clinicians. One ONC staff member, Jacob Reider, MD had some interesting comments that focused on "The User Experience." His comments spanned the continuum of User Experience with a framework for how tools and/or applications can/should evolve.
Functional (it does what it is claimed to do)
Reliable (it works consistently)
Usable (it works in a way that is consistent with the user’s expectations)
Meaningful (it does something important or valuable)
Pleasurable (it is enjoyable to use)
So, I will end with one thought. Even if the system meets "Useability" standards for clinicians, achieving quality health data analytics still requires that accurate, timely and quality data is entered into the EHR avoiding the Garbage In-Garbage Out phenomenon.
As clinicians, do we ever wonder how excellent patient care can be achieved? Do we become too involved in our deadlines, our tasks, or our own needs and lack the time to reflect and to improve? It is certainly an issue in today's healthcare environment as the delivery of care changes in the path to Meaningful Use...
Well, I watched this video today, posted by Brian Ahier. It is an epic portrait of how one individual came up with an idea that would provide quality care/experience to customers.
Click this link to watch the video - a moving and heart-felt story.
May you have a Happy and Safe Holiday Season!
The Holiday Season is upon us. People are racing through the malls making sure to get that "just right" gift for friends and loved ones. The Holiday Season has become a shopper's heaven, the hedonic opulence of our times - if only for those who have available resources. When did this phenomenon appear? Have we lost the goal of living a meaningful life? A term the ancient Greeks called eudaimonia.
Several months ago I read the book Last Acts: Discovering Possibility and Opportunity at the End of Life, written by David J. Casarett, M.D. One might say, why would you read such a sad book? I would respond by saying that the compassion we show to those who are dying and to their families and friends during a time of great sorrow can become respectful, uplifting memories of that person's life. This compassion then elicits reflections about a meaningful life; a celebration of the life they led with its achievements and last desires.
Celebration of life then, evokes the question, "How do we know if we have lived well? First, I might say it is a spiritual question and one that can only be answered within. However, this Harvard Business Review article provides an interesting soliloquy of psychological realism in today's hard times. Consider the recent Occupy Movements and its dispersion across the nation. Umair Haque, in his HBR article above, describes "the heart of the economy today.."
Instead of an "energy industry," I see a resource addiction that saps money and preserves self-destructive expectations. I see, instead of food and education "industries," an obesity epidemic and a debt-driven education crisis. Instead of a pharmaceutical industry, I see a new set of mental and physical discontents, like rates of suspiciously normally "abnormal" mental illnesses and drugs whose lists of "side effects" are longer than the Magna Carta. Instead of a "media industry," I see news that actually misinforms instead of enlightening — rusting the beams of democracy — and entertainment that merely titillates.
I found Umair's article insightful; reminding me of our current health care crisis, nations across the globe wrestling with financial/debt issues, and people and families in need almost everywhere. It's not the world I remember growing up... where children had high hopes for college and secure financial futures for themselves and their families. No, those times have all but disappeared. We live in a new age.
So for those of us seeking a well-lived meaningful life in this new age, take a few minutes to contemplate these items from Umair's article:
We are the creators of the future.
This last statement resonates with me. Our children and our children's children have a tough road ahead, but with their courage and creativity they may find new insight into some of the toughest issues we face today. This is my hope.
To all, Seasons Greetings and Best Wishes to all for a Happy and Safe Holiday Season.
In Monday's EHR Watch news, Dr. Hitchcock presented five key reasons why CDS should be used in the hospital ED. Robert Hitchcock, M.D., F.A.C.E.P., is vice president and CMIO, T-System, Inc.
While clinical decision support should not replace a provider’s knowledge, experience, intuition or judgment, it can complement the clinician’s skills and enhance the quality of care provided. The ED is an ideal setting for tools that help reduce the incidence of preventable medical errors and adverse events.
I am very supportive of the need for better information at the point of care. ED environments are fast paced and filled with opportunities for mistakes. Given the history of medical errors in the US, the need for better information, for the right patient, the right provider, at the right time and for the right reasons, effective use of Clinicial Decision Support Systems has strong potential to improve clinical decision making.
More information can be found at the link for this article.
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