Recovering from DC Health Data and Innovation Week

By Gregg A. Masters, MPH

Whoa! What a week in DC. The events stacked back to back were fast, furious and content rich. I previewed the week here.

There is much to report, including my upcoming on ‘This Week in Accountable Care‘ interview with JD Kleinke, pioneering health care information entrepreneur, medical economist, author, and business strategist, this Wednesday at 12 Noon Pacific/3PM Eastern. We’ll discuss ACOs, health reform and more with one of the brightest thinkers in the health policy and consulting space.

Meanwhile, here is my summary of tweets associated with Day 1 of the Third National ACO Summit, Day 2 to follow shortly:

[View the story “Third Annual ACO Summit: Day 1” on Storify]

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.

Today on MU Live Radio: ACOs & Meaningful Use Connecting the Dots

By Gregg A. Masters, MPH

ACOs, Meaningful Use (aka MU), the persistent ‘whitewater’ of health reform and the quest for the elusive ‘triple aim’ will be at the center of our chat today on Meaningful Use: MU Live Radio.

MU Live! is a 30 minute internet talk radio show hosted by our HITECH Answers experts. Our session experts discuss breaking news and issues on meaningful use as well as other health IT topics.

For more information including past guest segments, click here. To register to listen to today’s broadcast at 11AM Pacific/2PM Eastern, click here.

A Gentle Appeal to Healthcare Social Media Thought Leadership

By Gregg A. Masters, MPH

It takes courage to live a life of consistent integrity. Owning the occasional ‘wreckage of one’s presence’ (you know when things don’t go your way or as planned) can at times be an emotional and intellectual stretch. After all, we do live in a society that often embraces the transfer (vs. ownership) of one’s ‘guilt’ to another party. Whether you call it proactive risk management or ‘socio-pathetic’ behavior the common denominator is to distance oneself from the consequences of ‘failure’ or disappointment.

Let’s be real, we all have obligations including financial, professional, family, community, etc. Yet in our busy and challenging lives especially in a trying, somewhat unstable, and paradigm shifting digital economy honoring Sinclair’s challenge is a worthy reflection:

It is difficult to get a man to understand something, when his salary depends on his not understanding it.

More recently and perhaps best expressed by Steve Jobs’ legendary challenge to John Sculley, the then President/CEO of PepsiCo:

Do you want to sell sugar water for the rest of your life or do you want to come with me and change the world?

The same sensibilities if not value proposition choices remain with us today. If anything the stakes have gotten considerably higher.

Our ‘healthcare borg’ is failing many. It’s unrestrained appetite and unaccountable under-belly are no longer limited to internal esoteric debates among health policy wonks or healthcare leadership. The entire US economy is now at stake. So the question if not challenge I offer to the healthcare social media talent pool is:

what are you doing to advance the triple aim?

For those not necessarily tethered to the details of health policy, or transformational imperative debate, let me summarize the goal posts below, courtesy of Health Affairs:

Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an “integrator”) that accepts responsibility for all three aims for that population. The integrator’s role includes at least five components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.

So with all due respect to your moral code, values and obligations (especially to those who sign your paycheck or who’s mouths you feed), ask yourself if your actions in social media advance the cause of the triple aim? If not, please re-evaluate how you are deploying these very powerful collaborative and engagement tools?

For example, is it in service of an unsustainable if not ‘value subtraction’ business model? If you have trouble connecting with ‘eligible entities’ or who might otherwise fit into this bucket, you might want to review Paul F. Levy’s recap of Clayton Christensen’s view of the health care world, as set forth in ‘The Innovator’s Prescription.’

So  be bold, use the power of these tools wisely. Just ask yourself: ‘what am I pretending not to know?’ Don’t be a vehicle that breaths life into failing or ‘net community negative’ institutions’ or interests. Take a stand! Make it about the ‘all in healthcare eco-system’.

More later on that one!

ACOs, PCMHs and Risk Contracting: A Primer

By Ben Miller, PsyD

Accountable Care Organizations (ACO), according to NPR, takes “up only seven pages of the massive new health law” yet has become one hot topic in healthcare circles. What are ACOs and what implications do they have on the community?

Well first, let’s define an ACO:

Accountable Care Organizations are partnerships between healthcare providers designed to be accountable for the quality and cost of the healthcare they provide in return for financial incentives. How these partnerships are implemented may vary, with some focused purely on primary care, while others include sub-specialists and hospitals. In all cases, primary care is expected to form the core of these organizations, the center of the wheel, and base for the ACO.

As we have discussed before on this website, primary care is so central to many health redesign efforts because it can help the system attain the triple aim (improve healthcare quality and patient experience, as well as reduce overall healthcare costs).

The promotion of ACOs is an exciting and innovative aspect of the Patient Protection and Affordable Care Act (PPACA). However, as with many things in healthcare, the devil is in the details. Much of the benefit and potential benefit for ACOs be found primarily through the Medicare Shared Savings Program (MSSP).  MSSP  is described in proposed regulations published by the Centers for Medicare & Medicaid Services (CMS) on April 7, 2011; however, the influence of the ACO regulations on the nation’s health system will extend beyond the MSSP.

ACOs are risk-bearing entities and require capitalization. To this end, hospitals and other healthcare professionals like physician groups are partnering with insurers to form these entities. The partnerships that participate in the MSSP will likely cross over into commercial plans, and Medicare will not be the only health insurer to benefit from the cost reductions realized by ACOs.

There appear to be some interesting opportunities within ACOs to deliver unique healthcare innovation. It is important, as with most healthcare initiatives, that the community be aware of what is happening at a macro level in order to be best informed on how to engage their healthcare community.  While ACOs can be confusing, the better we as a community understand the opportunities and implications, the more likely we are to have our voice heard. After all, someone outside of CMS is also going to need to say if this is working or not.

And of course, with any effort to change how healthcare is delivered, we must examine the payment mechanism.

There are three financial incentives models for ACOs: shared savings, savings bonus plus penalty, and capitation. Each of these tiers are characterized by increasing risk and benefit while decreasing the system and provider’s dependence on fee for service and with capitation, ultimately eliminated. This is a major step for healthcare as we can start to move away from fee for service (OH has written about FFS extensively here).

Shared savings allows for organizations to receive a portion of the amount saved compared to predicted costs in addition to regular fee for service payments. The savings bonus plus penalty model is similar to the shared savings model, with the addition that the organization must take responsibility for any excesses in spending, therefore increasing risk and potential reward.

What’s potentially very exciting is what happens when these savings are shared back into the community? Many interesting opportunities may unfold at this juncture, but how this will play out remains to be seen.

Since one of the goals of the triple aim is to enhance patient experience in healthcare, how do ACOs do this? Or do they? It’s a question that with every healthcare effort we should be asking.

  • How does an ACO make healthcare more patient-centered?
  • How does an ACO provide healthcare services that are more effective?
  • How does an ACO encourage providers to start to address health rather than just sickness?

The first step in helping answer these questions will come back to having a basic understanding of ACOs and their function in healthcare redesign. Have you seen ACO efforts emerge in your community? If so, what has your experience been? What thoughts do you have about this approach?

The ‘Looking at what’s to come: Accountable care organizations’ blog entry originally appeared in Occupy HealthCare.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

The Incidence of ACOs: The Leavitt Report

By Gregg A. Masters, MPH

We’re seeing a flurry of reports on ACOs quoting the Leavitt Partners report ‘Growth and Dispersion of Accountable Care Organizations‘ published last year, see previous post for access here.

Meanwhile we chatted with report authors Andrew Croshaw and Thomas Merrill who provided additional context and insight into their findings on ‘This Week in Accountable Care.’ To listen, click radio show image to the left.

IPA + HIT (aka technology stack) x MSO = ACO

By Gregg A. Masters, MPH

For those not familiar with the ever expanding ‘acronym soup’ we often take for granted inside the healthcare borg:

I/P/A = Independent Practice Association | H/I/T = Health Information Technology | M/S/O = Management Services Organization

Judging by the ‘anemic’ numbers specific to CMS forecasts for participants in the broad brush ‘ACO program’, from Medicare Shared Savings to the more recently added Pioneer class extension, many on the provider side feel somewhat vindicated in their reluctance to dive into round one – at least officially.

Yet, an accumulating series of reports from the front may be causing some reconsideration of the wisdom to watch while others lead (aka risk innovation). The ACO ‘sentiment meter’ is on it’s way UP. For example in the last 24 hours alone (and this doesn’t count some of the more favorable reporting over the last few months) the following piece effectively summarizes the key insight.

Field report: One Pioneer ACO’s 9 early progress point

Courtesy of Massachusetts based Mount Auburn Cambridge Independent Practice Association (MACIPA), one of 32 Pioneer ACOs recognized by CMS, they distill their key operational and development challenges from this perspective:

‘Jeremy Davis, who heads MACIPA’s Project Management team, explained that for his organization the pilot is essentially…’

a natural offshoot of what we already do.

While MACIPA is arguably in an ACO ramp-up phase of their glide path, forward tangible progress is charted via the following 9 program milestones:

  • Documenting activities to help create a methodological approach to becoming an ACO, with the ultimate goal of developing a repeatable implementation model.
  • Developing a mechanism to identify ACO patients for clinical teams at the point of care, to better coordinate outreach programs such as home healthcare, rehab, and skilled nursing care.
  • Delivering letters to all Medicare pilot patients, providing an overview of the program and patient consent model.
  • Identifying reporting requirements for the 33 measures CMS will evaluate, which will include a key focus on patient satisfaction measures, as well as screenings and assessments.
  • Working with IT infrastructure vendors to create a reporting toolkit for clinical alerts, reporting dashboards, and automated data extraction tools.
  • Educating healthcare partners and data suppliers on program goals and securing buy-in for care coordination, including hospital discharge and follow-up procedures.
  • Developing additional care management resources to monitor delivery and ensure that patients receive efficient and appropriate hospital care, medication reconciliation on prescribed medications and follow-up visits.
  • Developing additional social worker services programs for community-based patient outreach.
  • Adding a patient advocate board seat to the MACIPA Board of Directors.

[Read original article here.]

There is much more to share. In a follow-up post I will stitch together a series of posts, articles & reports to back-up my ‘ACO sentiment meter’ claim.

As always, your thoughts or counter argument  is invited.

DC Health Innovation Week: A ‘Triple Aim’ Love In or More Silo’s In the Making?

By Gregg A. Masters, MPH

As we trudge forward into various iterations of what and how ‘accountable care’ strategies can be sensibly configured and locally seeded for Medicare, Medicaid as well as commercial markets, attention is often focused on the ‘necessary’ but ‘not sufficient’ contribution(s) from health information technology (HIT). It is rare that a conversation centered on accountable care or ACOs in particular doesn’t shift to HIT, where EHRs, HIE’s (heath information exchanges) or other data banking or connectivity solutions aren’t a material part of the dialogue. Often posited as the central spine enabling the required coordination and integration essential to accountable care, the technology side of the challenge frequently preempts other issues including physician culture, clinical and financial risk management tolerance and sophistication, or the history of successful physician/hospital joint ventures, in the local market.

Yet in the paradigm shift from volume to value via accountability many are focused on the presumptive return expected from consumer empowerment and electronic health information connectivity. Whether couched as informed choice via up-leveled health literacy, e-patient activism, ‘data liquidity’ or the litany of supportive ‘apps’ including mhealth, wireless or other prevention and wellness oriented platforms, the consumer empowerment movement incentivized by HITECH and further challenged via the triple aim quest are energizing many entrepreneurs, healthcare providers and even regulators.

In June we’ll witness another round of broad based healthcare stakeholder engagement during Health Innovation Week in Washington, D.C. For context, check out Wil Yu’s post on the Healthcare Blog titled: Breaking Down the Process of Innovation: The Value of Community.’

Starting with the Health 2.0 sponsored code-a-thon and [coincidentally] ending with the 3rd Annual National ACO Summit, with HealthCamp DC, Regina Holliday’s ‘The Walking Gallery‘, and the jointly sponsored Institute of Medicine’s and Department of Health Services HDI Forum aka ‘the Health Data Palooza‘, the week will be full of learning, networking and collaboration opportunities.

ACOwatch will be onsite and reporting from several of the venues. Where possible we’ll broadcast recaps, and even livestream all or portions of select events. Minimally you can expect a generous outbound tweetstream via @ACOwatch, ACOalliance or @2healthguru.

The Medicare Shared Savings vs. Pioneer ACOs

By Gregg A. Masters, MPH

During the ‘risk download days’, i.e., from health plan to physician groups or networks and institutional health systems or hospital partners, whether via global percent of premium, or budget driven PMPM contracts, some of us used to joke that using healthcare actuarial data to manage forward clinical risk was like driving your car via the lens of a rear view mirror (note: this is the pre-‘Google car’ era).

In fact some of us even were known to whisper in these sessions that actuaries where kind of like accountants albeit with a ‘charisma bypass’, yet none us would consider for a nano second assuming the risk of these full risk global deals without the aid of a competent actuarial advisor.

One of those players then and remaining so today is Milliman who’ve recently published a briefing on the difference between those ACOs functioning under the terms of the Medicare Shared Savings Program vs. the more ambitious and perhaps flexible Pioneer program. This is an excellent primer on ACOs, including a summary of risk, incentives and associated performance benchmarks.

Health Reform Readiness Infographic

By Gregg A. Masters, MPH

We all love infographics, right? This one caught my eye today. Kind of a clever snapshot of the crap shoot we’re in relative to the legal and political uncertainty festering in the US today. The original graphic is courtesy of @HITconsultant via his blog here.

Whether this captures the essence of our health reform readiness or not, the survey findings are summarized as follows:

  • Despite intense debate, over 80% of health plans are implementing Healthcare Reform (HCR) initiatives
  • Consumer experience tops the agenda on the 2012 priority list for health plans with a focus on member satisfaction and service
  • 80% of health plans are in the “wait and watch” mode and only in planning stages with their Health Insurance Exchange (HIX) initiative
  • Nearly 40% of health plans are already implementing Accountable Care Organizations (ACOs); more than half are in planning stages