A Health Information Technology Framework For The Accountable Care Environment

Abstract

Under the Affordable Care Act, certain provider groups can take on escalating levels of financial risk as they became more accountable for the quality and cost of the care delivered to Medicare beneficiaries. These Accountable Care Organizations (ACOs) as defined by the Centers for Medicare and Medicaid Services (CMS) encompass three types of Medicare Shared Savings programs – upside risk only, up and downside risk, and advance payment – and the Pioneer ACO program. All are required to demonstrate that they can promote evidence-based medicine and patient engagement, coordinate patient centered care, and report on quality and cost measures for internal use as well as to CMS. A number of commercial insurers are also offering similar types of risk-based accountable care arrangements to selected provider groups, whether or not they are engaged in one of the federal programs. To date, there are over 400 provider organizations engaged in some form of accountable care. Unlike the capitation models contracted by commercial insurers as Health Maintenance Organization (HMO) products in the 1990s, today’s arrangements emphasize quality and patient-centered care. They also rely on health information technologies which hold significant potential to enable high value care. But the promise of accountable care is tempered by a dearth of experience with care-process redesign and culture change and of knowledge about the health information technology (HIT) infrastructure necessary to optimally support health care transformation. There are many factors that will contribute to the success or failure of an organization in the accountable care environment. One that will determine an ACO’s success is the presence or absence of a focused HIT roadmap that aligns an organization’s limited resources with its goals and objectives for accountable care. Without clear guidance in identifying and prioritizing their HIT needs, many provider organizations are struggling to develop their roadmaps. The Certification Commission for Health Information Technology (CCHIT) – a not-for-profit HIT certification body with an educational mission – recognized that, in the current accountable care environment, something is missing: a structured approach that would help providers identify the most effective, highest-value HIT investments that would meet their specific needs. Its Commissioners and a specially convened Expert Advisory Panel (listed in Figure 1 below) therefore developed a publicly available HIT Framework for Accountable Care. The Framework is designed to serve as a starting point not only for provider groups developing their HIT roadmaps, but also for payers looking to assess and/or complement the HIT capabilities of their contracted provider partners, and for developers designing systems and products to fill the gaps in currently available technologies.