The Role of Technology in the Formation of Accountable Care Organizations

Michigan Medical Law Report, summer 2011

By: Amy K. Fehn, Esq.

Wachler & Associates, P.C.

Providers interested in forming or joining an Accountable Care Organization (ACO) for purposes of participating in the Medicare Shared Savings Program (MSSP) should be aware of the important role that Electronic Health Records (EHRs) and other technology will play in the ability of ACOs to meet eligibility criteria and successfully participate in the MSSP.

Reporting of Quality Measures Through the Use of Technology

ACOs participating in the MSSP must not only demonstrate cost savings, but must also demonstrate their ability to maintain quality care, as measured by designated quality measures. CMS has prescribed methods for reporting these measures, many of which will require the use of health information technology.

Of the 65 initial quality measures designated by CMS, 47 must be reported through the Group Practice Reporting Option (GPRO) Data Collection Tool, which will be an upgraded version of the GPRO tool currently used in the Physician Quality Reporting System (PQRS). The current version of the GPRO Data Collection Tool is web-based; however, CMS plans to develop the capability of the GPRO tool to interface with Electronic Health Record (“EHR”) technology so that the EHR data could directly populate the GPRO tool with required quality data.

The use of EHR technology will not only be important for reporting through the GPRO tool, but will also allow the ACO to meet additional quality measures, since many of the proposed quality measures are identical to “meaningful use” measures found in the Health Information Technology for Economic and Clinical Health (“HITECH”) EHR incentive program.

Achievement of 50 percent Meaningful Users by the ACO’s Primary Care Physicians

In addition to the quality measures that are aligned with the HITECH meaningful use requirements, CMS has proposed requiring ACOs to demonstrate that 50 percent of its primary care physicians are meaningful EHR users, as defined by the HITECH Act, by the beginning of the ACO’s second year of participation in the MSSP. CMS has also indicated that it plans to greater align the EHR incentive program and the MSSP in future rulemaking.

Internal Reporting on Cost and Quality Measures

In order to effectuate change in the way that healthcare is delivered and achieve the “triple aim” of better care for individuals, better health for populations and decreased growth in health care costs, ACOs will need to be able to internally monitor participants’ performance with regard to quality and cost measures. CMS is proposing that, through the application process, an ACO will be required to describe its process to report internally on quality and cost measures and explain how it intends to use that process to respond to the needs of its Medicare population and make modifications in its care delivery. CMS has provided several examples of ways that health information technology could be used for this type of internal monitoring, including population health data management and implementation of practice and physician level data capabilities, such as point of service reminder systems.

Coordination of Care

CMS has also proposed that ACOs be required to define processes that promote coordination of care. Some of the suggested processes include the use of EHRs and/or participation in a health information exchange (“HIE”) so that the ACO can provide treating providers with a beneficiary’s summary of care record during transitions both within and outside of the ACO. CMS also discussed the use of predictive modeling, remote monitoring and telehealth as ways to use technology to improve coordination of care.

In addition to being a required process that ACOs must define, care coordination is necessary for meeting the additional requirement of patient centeredness. In discussing the proposed “patient centeredness criteria”, a mainstay of the MSSP, CMS highlighted the importance of having information follow the patient. This is most effectively accomplished through the exchange of electronic health information and providers who are enrolled in the Medicare EHR incentive program will be required to develop coordination of care processes that are consistent with the meaningful use requirements.

Meeting Additional Patient Centeredness Criteria

In addition to care coordination, additional patient centeredness criteria set forth in the Proposed Rule will require the use of technology. For example, an ACO will be required to evaluate the needs of its assigned population and develop plans to address those needs. ACOs will also be required to have systems in place to identify and update high-risk individuals and to develop individualized care plans for targeted populations. ACOs must also be able to measure clinical performance by physicians and provide feedback to the physicians so that they can use the measures to improve care. Thus, an ACO will be required to have the ability to access and analyze a large volume of data from all of the various ACO participants, and the use of health information technology will be the only way to efficiently perform this function.

Yet another element of the proposed patient centeredness criteria will require ACOs to develop processes for giving beneficiaries access to their own medical record. While access to the medical record can be accomplished through provision of a paper copy, this is a burdensome and time consuming process for both providers and patients. CMS has also indicated that access to the medical record would allow the patient and his/her family the ability to participate in care and the medical decision making process. Thus, it appears that CMS anticipates more immediate access than a paper copy would provide. For example, the use of a patient portal or the ability to import medical information into a patient’s personal health record in a timely manner would appear to be more closely aligned with CMS’ vision of patient centeredness than access to a paper copy of the medical record.

Conclusion

In addition to the incentive payments available for demonstrating meaningful use of certified EHR products, providers and organizations who embrace technology will also be in the best position to successfully participate in the MSSP. When discussing alignment and structure, prospective ACOs should also consider technological capabilities of proposed participants.