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Promoting accountability in ACO - A few insights (Part 2)

In the previous blog, we have introduced the two key concepts that are going to influence the success of an Accountable Care Organization (ACO):

• Establishing and adhering to a central Vision

• Establishing a standard clinical process and benchmark

In the previous blog, we had started the discussion on the first topic i.e. Adherence to a central vision, and here we will extend our discussion further on the same.  It has been observed that one of the primary reasons of higher cost of healthcare in the U.S. is the existence of the fragmented healthcare delivery organizations. Collaboration among the constituents has been suggested as one of the solutions if one wants to succeed as an ACO. But is it enough to put a right setup of people, process, technology and infrastructure? Most importantly, the ACO organization has to plan for an effective change management so that the gap between the current and future states in all the areas of healthcare continuum can be bridged.

The vision will drive the change management process as it sets out the final objective very clearly before all the constituents.  Each of them needs to evaluate to what extent its current processes and practices will take them towards the vision. Then in such cases what are the key focus areas that are to be assessed? The assessment will not exclude any of the stakeholders (for example, providers need to assess the impact to the members towards improving provider-member collaboration). One important area that needs to be kept in mind during assessment phase is establishing mechanism to build trust among the stakeholders in the proposed state and minimize the silos currently existing.  Providers do not trust the clinical data maintained by the members which is one of the main reasons behind the alienation of PHR (personal health record) data. All of us know Google is withdrawing its Google Health service due to lack of membership.

Requirements for regulatory compliance from CMS and other federal and state regulatory authorities will play an important role in the assessment phase. One of the current rules of the Medicare Shared Savings Programs (MSSP) mandates that at least 50% of the participating providers in an ACO must be meaningful users of EHR. There are rules on adoption of outcome based payment model in ACO. The extent of change required to change the prevalent fee-for-service reimbursement model in the Non-ACO model to adopt the outcome based payment model will be another critical inputs to the assessment. Another important aspect will be how to establish collaboration between providers and the members especially in terms of establishing a centralized accessible patient health records without maintaining separate systems for personal health records. These are a few scenarios mentioned here for illustration purpose and there other rules as well.

All these factors need to be accounted for in the assessment leading to effective change management strategies. For example, there is a central clinical strategy and IT strategy. The central assessment will decide whether a new process will be established or already established systems/processes will be leveraged and integrated to form the central processes. Each individual constituent need not spend time and material to establish their own framework rather they can use a centrally established infrastructure/framework. This way, the cost will go down significantly and also will ensure right collaboration.

The important thing here is each of the constituent organizations needs to bridge the gap between the current state and future state in an ACO organization. This governance responsibility can be owned by a central group covering all the stakeholders. The central governance team has a very critical role to play in managing various processes and doing conflict resolution.

IT can be leveraged here to a great extent in spreading the awareness. Since the main purpose is to improve quality of care and reduce cost, the providers need to know and understand "How" and "What" part of the whole initiative. Each individual constituents need to be involved in forming the strategy which will help get a buy in from all. The required mechanisms need to be in place for collecting and analyzing these data and presenting before the central governance team. A lot of efforts need to be spent in this direction because it is very important that everyone is aligned with the vision. The important concerns need to be resolved before taking off as an ACO organization.

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