Accountable Care

Many providers are at a crossroads right now: Either join an accountable care organization or be placed into Medicare’s Merit-Based Incentive Payment System. Set to begin in 2017, MIPS uses value-based modifiers to rank providers by quality and is expected to fold together with meaningful use, essentially merging the current pay-for-performance models under one umbrella. MIPS is part of the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA, which repeals CMS' Medicare Part B Sustainable Growth Rate reimbursement formula and replaces it with a pay-for-performance model. Providers can choose to join an ACO or be part of MIPS. "People are waiting with bated breath for MIPS rules, just like they were for meaningful use," said Tom Lee, CEO and founder of SA Ignite, which develops analytics tools to help providers keep track of complex government programs. "The biggest thing on the horizon is there are a lot of details on this that will come to light when the rules come out." [Also: Behavioral telehealth key for ACO success] "MIPS has higher bonuses, but higher risks," Lee said."Providers don't need to choose a physician group to be a part of the program, but those providers who don't remain on top of the heap lose money.” The rules are due to be finalized by November. Although Acting CMS Administrator Andy Slavitt has hinted draft rules may come out as soon as this spring. When choosing a program, providers must assess the risk and whether they want the guaranteed 5 percent from ACOs or choose MPIS where the value-based swing between the lowest and highest reimbursement could be up to 36 precent when accounting for bonuses, Lee said.   [Also: Mostashari's ACO startup is growing] "ACOs are unproven, and most have been penalized; weigh that against costs to get the ACO up-and-running," Lee said.  The trouble is that many providers are struggling with a lack of resources, which makes it difficult to "poll through the information to meet these requirements," said Darren Barnes, director of quality and performance improvement, Southern Illinois University HealthCare. "In today's world of quality improvement, you not only have to provide quality care, but prove you can deliver," said Barnes. [Like Healthcare IT News on Facebook] Many ambulatory providers in particular are having difficulty transitioning into a quality management system, as "hospital measures are better defined than with multi-specialty ambulatory care organizations," Barnes said. "With data requirements and support, healthcare organizations are being asked to do more with less." Hospitals have a leg up on quality measure improvements, compared with physician practices. Where hospitals can assess workflows and certain measures on a daily basis, that's more challenging for small ambulatory facilities, posing a special challenge for participating in a physician reimbursement program. Moreover, data is hard to pull from the EHRs, said Barnes, and providers will continue to struggle "until we can build these systems to look at patient needs and improve the ability for patients to have access to the data for more personalized care." Twitter: @JessiefDavis

Privia Health will expand its work with athenahealth to ratchet up its focus on population health, the accountable care organization announced on Wednesday. Arlington, Virginia-based Privia Health will fully integrate athenahealth’s population health offering into its existing framework of athenaOne services for all 1,200 of its multi-specialty independent providers across five states and Washington, D.C. [Also: Jonathan Bush performs CPR on San Francisco sidewalk] Athenahealth will assign evidence-based health risk statuses to patients. The goal is to enhance patient engagement, and provide insight to better direct and align clinical protocols and team-based capabilities – all in an effort to provide value-based care. Privia Health CEO Jeff Butler credits athenahealth with helping the medical group become one of the top ACOs in the country, with care models and incentives fully-aligned around driving value into the system. In 2014, the first year Privia assumed shared-risk in the Centers for Medicare and Medicaid Services Shared Savings ACO model, Privia saved Medicare nearly $5.7 million and received half of that back in an incentive payment, according to CMS data. Privia Health has worked with athenahealth since 2014 to support clinical integration and connectivity between its medical groups and clinically integrated networks. Privia and athenahealth have already integrated athenahealth’s platform with Privia’s proprietary population health workflow systems and technology, bringing automation and scale to Privia’s programs that are focused on improving outcomes and reducing healthcare spending. Twitter: @HealthITNews

ACO quality measures were enhanced by pay-for-performance programs, according to the JAMA network, but providers also need advanced technologies, interventions, and close contact with patients. 

Many accountable care organizations are still struggling to overcome the challenges associated with health information technology integration, patient management and drug selection to improve care outcomes, according to a new study from the Pharmacy Benefit Management Institute.  In fact, fewer than a third of ACO providers use a single electronic health record system while 59 percent are on multiple systems and find it difficult to streamline and integrate them. Remarkably, PBMI found that 23 percent of ACOs still use paper charts. [Also: Behavioral telehealth key for ACO success.] PBMI surveyed 101 ACO providers, who cover over 30 million patients, specifically to analyze current practices in pharmacy management, the use of pharmacists in ACOs, the state of care management and patient engagement, clinical integration and future goals. The study found most ACOs use support tools in their practices: 90 percent utilize quality reporting tools, and 60 percent use point-of-care decision tools. However, only 34 percent of these respondents found these tools easy to use. "ACOs represent a critical and growing part of the solution to help improve value, quality, and care in our nation's healthcare and pharmacy plays an important role in achieving those goals," Jane Lutz, PBMI executive director, said in a statement. [Also: Steward Healthcare: ACO success hinges on IT strength] Almost all ACOs, 93 percent, said managing population health is very or extremely important, while an even greater majority of 98 percent said their focus on population health will increase in the next three to five years. The role of the pharmacist will be front and center, they said. Additionally, more than 60 percent of respondents said the use of biologics and specialty products and they expect genome testing will increase in the next three to five years [Like Healthcare IT News on Facebook] But health IT utilization among ACOs needs to increase for these goals to be feasible, the report said. Additionally, the pharmacist's role needs to be more prominent to support management goals to improve adherence, reduce inappropriate utilization and drug selection for better clinical outcomes. But only 57 percent of the ACO respondents currently employ or contract clinical pharmacists. More than half of the respondents said ACOs can decrease the cost of prescription drug therapy and another 69 percent said ACOs can increase the quality of prescription drug therapy. "Pharmacists are underutilized as trusted advisors to patients, physicians and other providers," according to the report. "Their patient-facing role can be very powerful in education and motivation, providing a potential solution to the lack of patient engagement and commitment to self-care." Twitter: @JessiefDavis

Accountable care organization Steward Healthcare recognizes that a robust IT infrastructure is crucial to the success of integrated care delivery.

Although the majority of organizations have made health IT a priority, integration and interoperability are still major hurdles for accountable care organizations, according to a Premier survey released Wednesday.

With 900 care locations and a 1,200-member IT team, Carolinas HealthCare System is sprawling and complex. That’s just how Chief Information Officer Craig Richardville likes it. Complexity creates excitement, Richardville, who was recently named the 2015 CHIME-HIMSS John E. Gall Jr. CIO of the Year, tells Healthcare IT News. “It’s just so dynamic that it creates the energy.” CHIME and HIMSS give the CIO of the Year Award jointly each year. The groups selected Richardville for the 2015 honor, they said, for “pursuing an aggressive and effective approach to employing technology to help provide better care.” Q: What do you view as your primary mission as CIO? A: To best serve our patients by engaging the optimal use and investment of technology and information for our patients and providers to improve their health and enhance care. Q: What is your proudest achievement? A: First and foremost, my family – watching my three sons grow and develop into fine young men and assets to our community. Professionally, the team – the complete CHS Team coming together to address and develop new and exciting ways of improving our services and connecting to our patients. Q: What has been the biggest challenge you¹ve had to face as CIO? A: Change management – ensuring that we lead the transformation of healthcare delivery. Q: How has your work changed over the years, and what factor has most contributed to the change? A: The biggest change is the addition from an executor of a plan, in with the development of the strategy. There are many ideas in and outside of healthcare that are applicable for us to evaluate and appropriately implement, so being part of the discussion over the last several years has allowed an opening of all minds, mine-included, to what the future possibilities are. Q: How has meaningful use changed the way you work? A: Meaningful use accelerated our plan and provided a discount to automate the clinical record and processes and to build a foundational platform for many other key initiatives to be built upon it, such as interoperability, patient engagement, mobility, virtual care, care management, etc. In that way it was beneficial, but the requirements and timeline and maturity of the service offerings has led to some of the frustration. To ensure we communicate our success and future progress, MU needs to be clearly identified as service and outcome-oriented for ensuring our work clearly puts the patient first. Q: Looking ahead, what challenges do you see coming in health IT? A: Interoperability. True interoperability based upon secure standards is absolutely necessary if we are to achieve the vision all of us share regarding making sure patients have access to their health information, and it’s easily accessible to their providers. Unlocking the data in our systems to share with providers and patients is crucial to creating a seamless health information system. It requires that we agree upon standards and safe transport protocols. It’s absolutely vital though that in order to serve our patients, we provide them and their providers with the health data they need to lead full lives. Also, patient engagement. Providing solutions that are easy, accessible and integrated into people’s lives is a challenge. Healthcare is good at building and deploying very feature-rich and complex software systems. What’s harder though is to deliver that sophistication into solutions that are consumer-grade, easy to use and accessible to consumers. It should be as easy as hailing a car on Uber, ordering a pair of shoes from Zappos, downloading a movie from Amazon or making a dinner reservation on Open Table. These solutions have to be integrated into the lives of people in a way that is not obtrusive but still help them manage and improve their health status. Q: What challenges are unique to Carolinas HealthCare? A: Carolinas HealthCare System has a level of complexity that may be similar to some but different from others. We are a multi-state health system with a large portfolio of combined assets, but also, in various markets, we have regional relationships that are a mixture of managed services, leased services and shared services. This complexity has allowed us to be very similar to other communities in that we have in some cases, like EMR for example, where we have been able to build core competencies around the higher layer services, such as health information exchange, patient engagement, data warehouse and analytics that contain a multi-faceted number of systems, products and solutions as opposed to a single platform like many others. Q: What new technology developments on the horizon have you enthusiastic? A: Mobility – placing the patient to be accountable for their health and wellness by providing the apps and connectivity for them to do so. Virtual care and it’s continued quick advancement and acceptance as a delivery model holding us accountable to the existing standards, yet improving access and lowering cost. Interoperability. FHIR appears to be very promising and we’re looking at ways here at Carolinas HealthCare System to use it to better build and deploy solutions for our patients and providers. Q: Where will health IT be five or 10 years from now? A: I would expect that we will be leading many other industries and that those in financial services, retail, etc., will look at healthcare IT for advancing their companies and industries, similar to how we are modeling some of our services offerings in comparison to them. There is a tremendous amount of talent within healthcare. We have arguably evolved quicker in this transformation that any other industry. With the management of the tight budgets that we hold ourselves to, we will inevitably be the one to lead the industry pack as we continue to help the business develop and deploy solutions that make it easier for patients and clinicians at a competitive price point. One of the things we’ve learned over the last 20 years, particularly here at Carolinas HealthCare System, is we’ve gotten very good at deploying solutions that are on time, on budget and deliver great value. Our teammates have great insight into how things work. We listen to and continue to better understand our patients, and how we can best optimize solutions and deliver value. I am very fortunate to be with a health system with a visionary board, and feel blessed to be part a group of colleagues that thrive upon teamwork and successful execution of our plans. Healthcare IT is not only playing the support role that we always have, but also leading and being a key component of many of our strategic initiatives. Twitter: @HealthITNews

Evariant, which offers a CRM platform for healthcare providers, raised $42.3 million in a Series C round of financing. Goldman Sachs led the funding.

Kaiser Permanente plans to build a medical school in Southern California, the integrated care giant announced on Thursday. The plan is to enroll the first class of 48 students in 2019.

Population health management is fast becoming a priority for healthcare providers, but many are still figuring out which technology partners are best suited to help them fuel data-driven initiatives, according to a new 2015 Population Health Study by HIMSS Analytics.