ACO Deadline Draws Near: What this Means for Providers

By Eric Zerneke

Since the entire healthcare industry is at HIMSS12 next week, this is a good opportunity to discuss an important deadline that will quickly follow the event. Accountable Care Organization (ACO)applications are due by March 30, 2012, which is the second, and potentially final, deadline.

For those of you wondering what this means, CMS’s Accountable Care Organization program is a new federally directed program incorporating new, and varied, pay-for-performance incentives. But what is an ACO?  An ACO is a group of doctors, hospitals and other healthcare providers along with 3^rdparty health insurers that work together to deliver high-quality care to their Medicare patients while controlling costs. They are “accountable” for the care,quality, and costs associated with a specific Medicare population.  The concept behind this program is simple – that higher-quality, proactive care where everyone is responsible and will be accordingly rewarded will lead to lower healthcare costs. This is especially true for chronic and high-risk patients, hospital readmissions, and duplicate labs and tests.

As discussed in InformationWeek’s February issue and what we hear from our clients on a daily basis, one of the key challenges is that organizations must have trusted, timely quality clinical and claims data and aggregate that data across the entire organization – including all their affiliate organizations.  Specifically, during year one, providers will have to report on 33 quality measures. These measures really hit at the heart of the national health crisis as they aim to answer the following questions:

• Are we creating coordinated care environments where patients feel like they are a contributor to the process?
• Are we effective in preventing waste?
• Are we able to help populations of patients achieve wellness in the areas of greatest impact?

In year two, ACO’s must report on eight of these measures and how they improved performance against those measures and lastly, in year three, they have to demonstrate significantly improved performance in 32 measures and report on just one that measures how well patients are functioning.

Despite the looming deadlines, this remains a daunting task and many organizations will continue to struggle to take action without a holistic strategy for managing information and tying this information directly to improvement programs.

Are you forming an ACO?  If so, how are you balancing the formation of an ACO with everything else on the schedule (ICD-10, Meaningful Use, PCMH programs, and more)?

Stay tuned, next week we will be reporting from the HIMSS12 floor and taking a deeper dive into how these challenges can be overcome.