Summit: ACO success tied to EHR, HIE capabilities

Mature electronic health record systems and health information exchange capabilities contributed to the success of five of the 10 accountable care organization demonstration sites funded by the Centers for Medicare & Medicaid Services.

The findings are preliminary and the project data is under review, said Anthony Rodgers, deputy administrator for CMS’ Center for Strategic Planning, during the National Regional Extension & Health Information Exchange Summit West Tuesday morning in San Francisco.

Still, the common denominator of advanced health IT for the five ACOs represents validation for health IT’s ROI. The five sites got the “lion’s share” of the $36 million that was the reward for meeting CMS’ goals of better care, reduced per capita costs and improved population health.

“If that’s not a business case, I don’t know what is,” Rodgers said.

CMS’ envisions three evolutions of the medical home, he said. Medical Home 1.0 encompasses EHRs, e-prescribing, coordination of care and patient care management, but no ROI. Medical Home 2.0 adds advanced clinical decision support and the broader application for chronic care management.

Medical Home 3.0, however, combines managing cost and population health with a fully connected office, community health strategy and new relationships and business partners, Rodgers said.

The industry, with CMS as part of the vanguard, is moving away from fee-for-service, episodic and non-integrated care to ACOs with EHRs and finally to patient-centered, integrated healthcare that aligns incentives with the three goals.

The model is organically aligned to achieve CMS’ goals, while also changing the financial incentives to global rates, shared savings and capitation, which will motivate groups to better manage their patients, Rodgers said.

Rodgers said he didn’t know when the peer review would be completed, but once the findings were complete the results would be posted on CMS’ Web site.