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Scope for leveraging IT in establishing patient centred care in an ACO

Better care for individuals is one of the important goals for the ACOs in the Shared Savings Program as established by the Affordable Care Act. This highest-level goal also known as the three-part aim consists of the following:
•Better care for individuals - As described in the Institute of Medicine report, it has six dimensions of quality: Safety, effectiveness, patient-centeredness, timeliness, efficiency and equity
•Better health for populations with respect to educating beneficiaries about the upstream causes of ill health
•Lower the expenditures by eliminating waste and inefficiencies while not withholding any needed care that helps beneficiaries

In this blog, we are going to explore the patient-centeredness criterion which comes under the goal "Better care for individuals" and how ACOs can leveraged IT to achieve this important target.
In the Institute Of Medicine's (IOM) report  "Crossing the Quality Chasm: A New Health System for the 21st Century" providing patient-centered care is defined as - providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Section 1899(b)(2)(H) of the Affordable Care Act requires an ACO to "demonstrate to the Secretary that it meets patient centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans."

The ACOs will need to explore leveraging IT in establishing clinical and administrative processes to meet patient centeredness criteria. The broad areas include the following.
•A mechanism to capture the patient's experience of care and use the results to achieve continuous improvement in care
•The ACO governance involves patients and other stakeholders. This requires a supporting IT applications which will enable the required flow of information and decision support.
•A process for evaluating the health needs of the ACO's assigned population and a plan to address the needs. IT can be leveraged in the data capturing, storing and analysis.
•Systems and processes to identify high risk individuals and processes to develop individualized care plans for targeted patient populations, including integration of community resources to address individual needs. Technology will play a key role in the identification and delivery of individualized care.
•A mechanism for the coordination of care - The ACO should have a process in place to electronically exchange summary of care information when patients transition to another provider or setting of care, both within and outside the ACO.
•Process for disseminating clinical knowledge (for example evidence-based medicine) to beneficiaries. This process should allow for beneficiary engagement and shared decision-making that takes into account the beneficiaries' unique needs, preferences, values, and priorities.
•Internal processes  for measuring clinical or service performance by physicians across the practices, and using these results to continuously improve care and service.

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