Towards a Framework of an ACO (Accountable Care) and Meaningful Use Crosswalk

By Gregg A. Masters, MPH

Lets begin with the core observation that both ACOs (or more broadly cast and therefore agile accountable care undertakings) and the Meaningful Use program are for the most part children of statute with intent to impact a less than optimal if not failing health care delivery and financing paradigm.

The former as a ‘modest’ component of the Affordable Care Act with a disproportionate share of the health reform consideration underway in many communities today. While the later is a ‘module’ if you will in the American Recovery and Reinvestment Act or more specifically via the provisions of the HITECH Act.

Lets first define an ACO

An Accountable Care Organization (ACO) is a network of physicians and other health care providers who are willing to work together and accept responsibility to improve quality and reduce the costs of health care services for a defined population.

According to CMS: ‘The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.’

‘When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.’

Meaningful use defined, per Search HealthIT:

Meaningful use (MU), in a health information technology (HIT) context, defines the use of electronic health records (EHR) and related technology within a healthcare organization. Achieving meaningful use also helps determine whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program.

It may be fair to describe the central intent of MU as follows: the focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.

So let’s be mindful that: Information technology is a necessary (but insufficient) element in the creation of the actionable health information essential to inform and guide clinical decisions at the point of care.

To begin connecting the dots consider the following ACO/HIT needs as a minimum crosswalk framework:

• A hospital EHR (including CPOE)
• A physician office or medical group EHR
• Health Information Exchange (HIE) or ‘integration platform’ to connect disparate providers in the care continuum (both acute and sub-acute)
• Further supported by a population health data management system
• With robust business intelligence and predictive analytics or modeling platform
• And lets not forget a user friendly consumer health platform or portal

What ties all of this together? Minimally the quality, coordination, and seamless care more typical of integrated delivery systems with HIT central spines, and the population based focus goals of accountable care organization.