Wednesday, April 13, 2011

HIT Essential for ACOs

A great deal of interest has been generated since CMS released the proposed rule for Accountable Care Organizations (ACO). As a result, many private sector healthcare organizations and CMS are exploring how HIT, electronic health records, registries, and other tools can be used to coordinate care to provide seamless high quality care for Medicare beneficiaries through ACOs.

On April 6th, leading experts came to a Capitol Hill briefing to discuss the role of health IT and ACOs. Neal Neuberger, Executive Director of the Institute for e-Health Policy, pointed out how ACOs and health IT will need to effectively interface and work together so that healthcare providers will be able to treat individual patients across care settings.

Senator Sheldon Whitehouse from Rhode Island stressed that a robust health IT structure is truly needed to coordinate care, reduce costs, and prevent fragmented care in our nation. The Senator said, “ACOs have generated a great deal of buzz with the release of the rules and most realize that health technology will be the framework for this new model of care.”

To make health IT even more effective, on March 10th, the Senator introduced the “Behavioral Health Information Technology Act of 2011” (S539) which has been referred to the Committee on Finance. The purpose for the bill is to make sure that health IT assistance is clearly provided to behavioral health, mental health, and substance abuse professionals.

Susan M. Christensen, Senior Public Policy Advisor at Baker Donelson as moderator thinks that the “Individual Health Record” will play an important role. The IHR would do so by integrating all clinical and financial data on a regional basis from original and unaffiliated sources to enable patients and physicians to use a common record.

Establishing an ACO means transformational change, according to Pamela Friedman, Vice President with the Strategy and Governance Practice of, Ingenix Consulting. She explained that it can be a lengthy, complex process that involves overcoming governance and legal hurdles, changing existing cultures, and implementing new processes and information systems.

Ingenix believes that a “sustainable health community” needs to be created. As Friedman explained the “sustainable health community” would require all participants of a community to function in harmony to achieve community health in terms of optimized care, quality, and result in lower costs. These communities must be connected, intelligent, and aligned with all of these elements to be operative and synchronized for a workable system to be produced.

Keth Figlioli, Senior Vice President of Informatics, Premier Healthcare Alliance described how the Alliance was put in place to reduce costs, improve quality, to mitigate risk, and shape policy and advocacy for members operates with over 2,000 hospitals and more than 70,000 non acute sites.

Figlioli further explained that health IT must be at the heart of the accountable care framework in order to build a patient centric system of care, to improve quality and reduce the cost for delivery system components, coordinate care across participating providers, use IT data and reimbursement to optimize results, and build payer partnerships.

An example of technology at work in a rural state was presented Lisa Harvey-McPherson, Vice President, for the Eastern Maine Healthcare System & Home Care Technology Association of America. She told the attendees that although the state is a large geographic area of 6,000 square miles, the Eastern Maine Health System (EMHS) is able to operate with a well organized network of local healthcare providers that offer high quality and cost effective services to their communities.

Harvey-McPherson discussed how important it is to provide homecare in the largely rural areas in the state. Just last year, the Eastern Maine Home Care (EMHC) staff drove more than 1.35 million miles to provide 67,997 visits to 3,581 patients in northern, eastern, and central Maine to provide nursing, therapies, social work, and hospice care.

Today, telehealth at EMHC involves patients uploading data daily to a telehealth nurse in Caribou Maine. A telehealth nurse calls the patient when they see clinical “red flags” on information sent online by the patient. At this point, the telehealth nurse determines what the next level of intervention should be.

This can mean making the decision to either make a home visit or to contact the physician. Since most clinical changes are handled by the telehealth nurse versus an additional home care visit, a savings of $120 is achieved every time telehealth is used instead of paying for a home visit.

As Harvey-McPherson explained the “Beacon Program” a nationally federally funded grant program was put in place to help communities build and strengthen their health IT infrastructure and exchange capabilities. The Bangor Beacon Community is just one of the 17 sites nationwide and now operating a three year project funded with $12.7 million. The funding from the Beacon Program will be used to build an EMR/IS system for EMHC and to provide additional telehealth units for all home care participants in the grant program.

The medical home using technology to coordinate care is gathering support. Martin Lipstick, M.D, Senior Vice President, Excellus Blue Cross Blue Shield Association discussed how the Rochester Medical Home Initiative is faring.

Rochester New York’s two largest health insurers, Excellus BlueCross BlueShield and MVP Health Care are coordinating and paying for the three year medical home initiative that now includes seven primary care practices and 21 doctors already using EMRs.

Each doctor receives funding to help cover their startup costs and to cover the cost of a care manager. The participating primary care physicians and practices are accredited through NCQA’s “Physicians Practice Connections-Patient Centered Medical Home” program.

The practices have found that their office care is improving, staff identifies with patients that have chronic diseases, and the staff is vigilant about contacting patients and scheduling them for appointments. As a result, physicians are spending more time with patients and seeing patients within five days of a hospital discharge to ensure that patients understand their treatment.

However, he commented on some of the challenges. Some of these problems are technological, economic, some political, organizational, and involve privacy and legal issues. Some additional challenges include practices using different EMR systems, doctors using idiosyncratic documentation, the lack of standard specifications.

The Institute for e-Health Policy holds the 2011 Congressional Luncheon Seminars behalf of the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics. This program has been ongoing for 19 years to inform the Members of Congress, Congressional staff, key Federal agency officials, industry professionals, and the general public on issues of immediate concern in the health technology field.

For more information, go to or email Neal Neuberger at or Arnol Simmons, Manager, Public Policy Initiatives at