An Accountable Care Organization (ACO) is a network of doctors and hospitals that work together to increase the wellbeing of a specific region or number of patients. The goal is to move away from the current model of being reimbursed per each test performed, to a model that would reimburse based on the overall health of the patients and effectiveness of the care provided.
CMS defines an ACO as a group of doctors, hospitals and other health care providers, who come together voluntarily to give coordinates high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
According to CMS, there are three organization-specific goals for ACOs to consider. These are improving care delivery, improving health, and reduce growth in costs through improvement.
Here is an example of what an ACO might look like. A regional hospital creates an ACO affiliation with a large clinic that provides multiple levels of services. There would be “centralized” registration where the patient would schedule appointments, check insurance eligibility, etc. This ACO has 7500 registered Medicare members. The hospital and providers are responsible for the well-being of all 7500 members and will get reimbursed based on the overall health and care of all the members. The reimbursement will then get divided between the hospital and providers.
What does this mean for IT?
Being able to share information across all organizations is critical to the success of the ACO and being able to lower overall costs of care for the members in the ACO. There could be multiple EHR systems that all participants will use. In this case, you will need to determine how you going to transfer patient information from one functional area to the other. In addition, robust reporting capabilities will be required to provide detailed information such as disease management or various quality reports. You will also need to focus on the security of these networks and the ePHI data that is involved. You should ensure your data is encrypted to the proper level per HIPAA security guidelines. One final item to consider is to ensure you have a disaster recovery plan in case of an emergency. Are you ready?