The rise of the accountable care organization (ACO) marks a change in the approach to healthcare delivery that affects your clients at all levels.
The move to ACOs represents an industry shift to on a focus on care coordination, quality improvement, and cost reduction — all facilitated by an emphasis on improved integration. This integration means that ACO members are concerned about population management, cost-effective care, streamlined clinical processes, proper reporting, and appropriate payment and reimbursement … all while maintaining a patient-centered focus. These values must be reflected in the IT solutions available to providers.
Here are a few tech building blocks that reflect the value shift that will become of growing importance to your client base.
- Revenue Cycle And Contract Management Applications: This is key to the modern healthcare provider’s navigation of accountable care and payment reform. Reimbursement environments are only becoming more complex, and providers need technologies that reflect that. Some of the new capabilities that ACOs will need include the following:
- aggregating charges to form bundles and episodes, with the aggregation logic enabling different groupings for different payers
- managing the distribution of payment for a bundle to the physicians, hospitals and non-acute facilities that delivered the care
- streamlining transitions between disparate reimbursement methodologies and contracts when billing and collecting
- providing tools for retrospective analysis of clinical and administrative data to identify areas for improving the quality of care and reducing the cost of care delivered
- Supportive Care Management Systems: The lines between individual and population health will continue to blur as ACOs grow. This means that care management system need to support proactive, preventive, and cost-effective care that fits both concepts in flexible ways. ACOs will want capabilities like care venue transition management, care coordination (utilization and case management), disease management, population management, and wellness management — all focused around preventing unneeded emergency department visits and acute episodes. Beyond that, disease registries will give providers the ability to identify cohorts of patients with specific care needs, review summary data sets, and step in when care is not at levels it should be.
- Rules And Workflow Engines: ACOs need efficient, predictable, and robust processes to thrive. To refine those processes, workflow and rules engines are big benefits in monitoring process performance and alerting staff to missed steps, sequence problems, or delays.
- BI And Analytics: ACOs will continue to rely heavily on performance metrics. Advanced data analysis, unfortunately, is still lacking in healthcare, so the growing need to assess care quality and costs, along with variations in practice and outcome comparisons, is not being met.
- Provider Interoperability: The importance of health information exchange platforms will only increase as affiliated providers need to share more information to facilitate patient care. Health information exchange platforms that enable secure data flow facilitate access to information needed for things like performance metrics, patient status, and patient events monitoring.
- Communication: ACOs are aligned with the new focus in healthcare to keep patients well, not just treat disease. Providers and patients alike will benefit from platforms like portals and social media channels that allow patients to communicate with care givers in secure, reliable ways that give them access to their data and tools for accurately addressing health issues.
When talking with ACOs as a solutions provider, it’s important to tie technology to benefits that they want to see in their patients and health populations. Talk of data, communication platforms, and revenue cycle may make sense, but it’s also important to draw direct and clear lines to the outcomes that they, as providers work for every day.