What role does technology play in the growing trend of community-based health care systems? According to the Final Rule for Accountable Care Organizations, Health IT plays perhaps the most important role of them all. Find out more about technology providers and how they influence the ACO incentive programs.

1. Health IT
& ACOs
Adele Allison,
National Director of Government Affairs,
SuccessEHS

2. Health IT is the ACO
Backbone. It will
create Winners and
Losers.

3. Certified EHR
Adoption is weighted
twice as much as
other performance
measures.

4. ACO Health IT exceeds the
“meaningful use” of an EHR
with IT needs for:
• Data Aggregation
• Care Coordination (E.g., Referrals) and
Population Management
• Revenue Cycle Management and
Reporting

5. ACO Tools of the Trade
• Membership and Provider Network
Management Systems
• Prospective and Retrospective
Payment Systems
• Utilization Trending and Reporting
Systems
• Patient Portals and PHRs

6. ACO Tools of the Trade
• Patient Survey Tools
• ACO-wide and Clinic-wide Digital
Dashboards
• Business Intelligence Tools
• Data Repository
• Patient Population Management
Systems

7. ACO Tools of the Trade
• EHR-based PQRS (GPRO)
• Advanced HIE

8. ACO Blueprint

9. Health IT
Patient
ACO Internal
Engagement
and External
Strategies
Governance
ACO Leadership Care Coordination
Patient-
Centered
Physician-Driven
Operations
Care Using Data and
Reporting
PCMH
PCPs and SCPs Continuum
of Health Care
“In-Network”
Referrals

10. Long-Term ACO
Decision Points

11. Extend Value
created to other
Payers/Employers

12. Systems and Processes
must consider:
• Participant Performance Metrics
• Operations/Data Exchange
• Medical Management (E.g., Case
Management and Utilization Review)
• Provider Contracting

13. Systems and Processes
must consider:
• Product Development/Benefit Design
• Marketing and Communications

14. Requires clearly
identified
Champion (E.g.,
CMO)

15. Requires
Community-Wide
“Buy-in”

16. Health IT &
ACO - Maturity

17. Beginner

18. Successful HIT Beginner
Requirement Milestone Technology Required
ACO Risk and Care Continuum Cost
• Membership
Accounting for Target
Revenue Clinical Events and/or
Information Tools
• AR Systems
Management Chronic Conditions
Patient Engagement; • Patient Portals
Episode of Care • Patient-Specific
ACO Beneficiaries Management; ACO Patient Education Tools
Support; "In-Network" • Referral Management
Referral Guidance System

19. Successful HIT Beginner
Requirement Milestone Technology Required
Provider Network
• Case Management
ACO Care Development; Case
Tools
Management; Protocol
Management Compliance Tracking and
• Population
Management Tools
Across Continuum Provider Utilization
• Digital Dashboards
Reporting
Clinical Read-only access based on
• e-Fax
Information user request (E.g., fax);
• Secure Email
Static Information
Exchange

20. Successful HIT Beginner
Requirement Milestone Technology Required
Data-mining,
Non-aggregated and
modeling with single-patient focused;
• Business Intelligence
financial and episode / encounter data
Tools (Reporting)
analysis; post-event
clinical analysis; clinical or financial
analytics/metrics
• ONC 2011/2012
CMS EHR Meaningful Use
ACO Beneficiaries Stage 1
Certified EHR
Technology

21. Intermediate

22. Successful HIT Intermediate
Requirement Milestone Technology Required
Provider Network
ACO Risk and Management and • Case Management
Revenue Contracting; Bundled- Tools
Payment Administration; • AR Systems
Management Payment Allocation
• Patient Portals and
Pro-active care
Secure Email
management; Social
• Patient survey tools
ACO Beneficiaries Networking (provider to
• Possible social
patient); Evidence-based
networking (E.g.,
Protocols
Forums, Blogs, etc.)

23. Successful HIT Intermediate
Requirement Milestone Technology Required
• Case Management
Tools
ACO Care Coordination of Care • Population
through HIE; Patient- Management Tools
Management Centered Medical Home • Digital Dashboards
Across Continuum Anchor • HIE
• Lab Interfaces
• Data Repository
Production HIE using CCD,
Clinical ingest only; Dynamic
• Limited HIE
Information Information; Push of
• Patient Portals
Information to Patient
Exchange Portals

24. Successful HIT Intermediate
Requirement Milestone Technology Required
Data-mining, • Dashboard analytics
and metrics
modeling with Population Management;
• Care Site-Specific
Continuum data
financial and aggregation; Predictive
Analytics
• Business Intelligence
clinical analysis and modeling
Tools
analytics/metrics • Data Repository
• ONC 2013/2014
Certified EHR (Stage 2
MU)
CMS EHR Meaningful Use
ACO Beneficiaries Stages 2 and 3
• ONC 2015 Certified
EHR (Stage 3 MU)
• EHR-based PQRS
(GPRO)

25. Mature

26. Successful HIT Mature
Requirement Milestone Technology Required
• Member Network
Management Systems
• Provider Network
ACO Risk and Management Systems
Revenue Full Risk Management • Prospective and
Retrospective Payment
Management Systems
• Utilization Trending
and Reporting
• Patient Portal
• PHR
Preventive and Chronic
• Patient Survey Tools
Disease Management;
ACO Beneficiaries Lifestyle Intervention /
• Remote Monitoring
and Self-Management
Consultation
Tools
• Social Media, at large

27. Successful HIT Mature
Requirement Milestone Technology Required
• Case Management
Established evidence-based Tools
ACO Care disease management and • Population
wellness protocols; Patient Management Tools
Management Health Maintenance • Digital Dashboards
Across Continuum Compliance; Provider • Advanced HIE
Referral Management • Lab Interfaces
• Data Repository
Clinical Fully digestible, real-time • Full, Bidirectional HIE
Information production HIE across full • Patient Portals
continuum; Full Patient PHR • PHR
Exchange

28. Successful HIT Mature
Requirement Milestone Technology Required
Data-mining, Real-time Population
• ACO-wide Digital
Management using
modeling with aggregated data across
Dashboard analytics
and metrics
financial and continuum of care; Provider
• Business Intelligence
and Patient analysis;
clinical Dashboard analytics and
Tools
analytics/metrics • Data Repository
metrics across continuum
• ONC Certified EHR
Market-specific, network Technology
and provider Clinical • EHR-based PQRS
Quality Measures (CQMs); (GPRO)
ACO Beneficiaries Behavioral Economics and • Evidence-based
Analysis; EHR-based Clinical Decision
Reporting Support Repository and
Tools

29. SuccessEHS &
ACOs

30. SuccessEHS ACO
Standards include
• Prospective / Retrospective Payment
Systems
• Utilization Trending and Reporting
• Evidence-Based Clinical Decision
Support
• Patient Survey / Questionnaire Tools

31. SuccessEHS ACO
Standards include
• Population Management Technology
• Digital Dashboards
• HIE in compliance with IHE Standards
• Patient Education
• Lab, Radiology and Device Integration

32. SuccessEHS ACO
Standards include
• Public Health related Integration
(E.g., State Labs, Immunizations Registry)
• PCMH Relevant Technology and
Toolkit – BIG
• Datacenter – BIG
• EHR-Based PQRS Reporting - BIG

33. For more information about
industry trends, visit
www.successehs.com for
white papers, articles, blog
posts and more!
Click here for our industry blog