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The Story of the Colorado Beacon Consortium’s ACO Plans

Posted on January 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There are a lot of aspects of the HITECH act that don’t get much attention. Sure, the majority of the spending is the EHR incentive money and meaningful use. So, we should focus on what’s happening with that money. However, much less attention gets paid to the other parts of the HITECH act since it’s only a few hundred million dollars (yes, I laughed when I typed that).

I do find it ironic that the “beacon” communities part of the HITECH act haven’t gotten much exposure at all. The whole idea of a beacon is to be seen by everyone, no? I’m sure each beacon community has had to submit some sort of lengthy reporting to ONC about their beacon community. I’m all about government holding people accountable for the money that they spend, but wouldn’t it be better if the beacon communities had to become true beacons in healthcare?

This rant comes on the heels of me watching this video from the Colorado Beacon Consortium. The video is professionally done and does a good job trying to capture the provider viewpoint of what they’re doing. It’s a little dry to watch, but really tries to show how the physicians and patients have benefited from technology.

Have you seen other examples of what the beacon communities are doing? I’d love to see more.

How do ACOs Deal with Non-compliant Patient?

Posted on December 22, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I have been thinking more and more about ACOs coming together and the ACO movement in general lately. Everything seems to be heading straight towards the ACO reimbursement model and so I think we all better start to consider what that’s going to mean to a clinic. Plus, in my case I’m particularly interested in how EHR software will enable the ACO to work properly.

It is quite clear to me that EHR software and technology in general will be one of the core pillars to a successful ACO.

As I thought about ACOs, the question came into my head: How will an ACO deal with a non-compliant patient?

Since the ACO reimbursement is tied to the health of the patient, then patient non-compliance becomes a really important issue. Plus, patient non-compliance is an incredible challenge since the physician only has so much control over a patient once they leave their office. In fact, they only have so much control of their patient even within their office.

I certainly don’t have all the solutions to this problem, and I’m not sure how reimbursement will handle a doctor who did everything right to improve the healthcare of a patient and they chose not to comply. However, this makes me start to think of ways that technology could help a doctor to improve patient compliance.

I’ve written before about some really great mobile health applications for people with diabetes. It was amazing to see how simple text message reminders could improve compliance by patients with diabetes. There are probably dozens and maybe even hundreds of other models where mHealth could improve patient compliance.

One of the real challenges I see with this is that much of this compliance could best be served by an EHR software connected to the patients. Unfortunately, most EHR software is so busy helping the doctor do what he needs to do in the office and meeting government guidelines that EHR software doesn’t have the focus to create these types of connections with the patient which could improve patient compliance. I’m not sure they will ever have this focus.

This is why EHR vendors need to fully embrace the idea of creating an ecosystem where smart “app developers” can create these patient compliance apps that connect directly into the EHR software. This won’t be easy for EHR companies to embrace, but those that do and do it well will be wildly successful. Plus, they’ll improve healthcare in the process.

Are there other ways that ACOs will deal with non-compliance by patients? I’d love to hear what people think.

Epic, Cerner Best For ACOs? Say What?

Posted on September 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I don’t know about you, but I’m not exactly sure what an Accountable Care Organization is. In fact, I’m betting nobody is — there’s a bunch of harrumphing and throat clearing out there, but I haven’t seen any crystal-clear descriptions out there.  Shall we say that ACOs are more honored in the breach than in the observance and leave it at that?

Now, we come to the puzzling part of this piece. If nobody’s managed to define an ACO clearly, how can any particular EMR be a better ACO tool than another?  We’ll have to ask KLAS about this one, since they’re the ones that discovered this “fact.”

Today, KLAS announced that it had interviewed 197 providers at 187 organizations to see how ACOs are forming up. A third of the respondents said that they were pursuing a formal Medicare ACO designation, and the majority were felt ACOs were the future, KLAS reported.

Sure, considering that ACOs are just risk-taking organizations with a capitated feel, some people already have a sense of what to expect. But throw an EMR into the mix and we’re in new territory — hopefully good territory, but new nonetheless.

So, tell me how providers know that Epic and Cerner are the most ACO-ready? Apparently, respondents believe that Cerner already has many of the IT pieces needed to run ACOs; moreover, they say Cerner is working closely with providers interested in the ACO model.

Survey takers also gave a nod to Epic, which they see as being close to ready (though behind in analyics and ability to share data with non-Epic users).

Wait a minute — let me get this straight.  Respondents know Cerner has the right pieces, even though the ACO doesn’t exist yet?  They like Epic, even though it doesn’t share data outside of its walled garden?  KLAS is kidding, right?

At this point, I’ll be kind and say that Epic and Cerner users are a bit brainwashed, which I too might be if I’d spent the kind of money those folks have on an EMR.

But the voice in my suggests that KLAS might have had its finger on the scales just a little bit. I will not publicly state that Allscripts, CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens scored worse because they didn’t pay for play…but something sure isn’t right here.

 

 

 

What’s Next in Health Information Exchange (HIE)?

Posted on September 21, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

There seem to be three big acronyms when it comes to healthcare IT and interoperability – EMR (electronic medical record), HIE (health information exchange) and ACO (accountable care organization). Implementing one does not always necessarily lead to the implementation of another. I’m sure everyone will agree, however, that an EMR most likely leads to connectivity to a HIE, which increases the likelihood of participating in an ACO or coordinated care program. I consider these technologies and concepts to be the interoperability triumvirate, if you will.

Of these three, the HIE seems to have seen its day in the sun. Enthusiasm for the concept and its surrounding technologies – at a fever pitch at tradeshows and in the media last year, in my opinion – seems to have been eclipsed by Meaningful Use incentive payments for EMRs and the general consternation related to ACOs. Which is why my interest was piqued when I came across news from a company called NexJ and its new Health Exchange solution.

In order to learn more about the product, touted by the company as one that “brings together the numerous electronic health records systems and applications that exist within healthcare organizations – many of them old, out-dated legacy systems – into one place so that healthcare providers can deliver better, safer, more comprehensive care,” I reached out to Oz Huner, Vice President of Health Solutions at NexJ Systems.

JD: What type of healthcare facility would be the typical customer for your new HIE solution?
OH: “The NexJ Health Exchange solution facilitates the sharing of patient information between healthcare organizations such as hospitals and healthcare providers, ACOs, HIEs, and public health and government agencies.

“Our customers are choosing our solution because it enables them to move from paper-based workflows to electronic workflows and gain such benefits as complete access to accurate information, improved quality of care and patient empowerment.”

Can you give me a specific example of how this HIE can potentially (or has already) improve patient outcomes at a client facility?
“In a current project we’re working on, NexJ is helping meet the challenges emergency department physicians and staff face by providing timely access to the patients’ primary care provider records when they arrive at the hospital admitting department. The NexJ Health Exchange solution connects the patient’s medical record directly with the emergency department systems, improving information sharing between community health providers and the hospital, and improving patient safety.”

Is there a limit to the number of EMRs and applications that can be connected within the NexJ health exchange?
“No, there is no limit to the number of EMRs and applications that can be connected using NexJ Health Exchange. It is highly scalable and can address the needs of the even largest healthcare organizations.”

Does it work with some EMRs better than others?
“No. NexJ Health Exchange provides open, standards-based integration to any EMR system. Its secure, Web-based portal and flexible architecture enables connectivity with legacy and proprietary systems, support for global messaging standards (HL7v2.x and HL7v3.x), exchanging of clinical document formats (CCR and CCD), and support for multiple standardized clinical terminologies (SNOMED, LOINC).

Based on your interactions with providers, do you feel that more and more are finally coming around to the idea of adopting EMRs and eventually HIEs? Or do you find that many providers still think they aren’t worth the expense?
“It is our opinion that EMRs have historically been of great value to healthcare organizations, but since they’re often siloed, such information technology has not been ubiquitously adopted. As an element of a HIE, however, we believe there will be greater EMR adoption as government incentives and programs encourage healthcare providers across the country make the switch to EMRs. As more physicians move to EMRs and become net receivers of patient information, they will realize the benefits of access to accurate information, improved quality of care and patient empowerment.”

Are you working with any regional extension centers around the country to promote your EMR and HIE solutions?
“Indirectly, yes. Through our partnership with Open Health Tools, NexJ is a member of the Platform Implementation Project (PIP), which is working on an open HIE solution for state agencies. The focus is currently on southeast Texas, but is by no means limited to that region.”

NexJ will be at the Health 2.0 conference in San Francisco next week. If you plan on going, stop by their booth and let me and your fellow readers know what you think about this new health exchange solution. Is HIE the buzzword worth bringing back?

Health IT Expenses Burden ACO Startups, But CMS Doesn’t Get It

Posted on May 16, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study sponsored by the American Hospital Association has concluded that developing an Accountable Care Organization is likely to be substantially more expensive than CMS has projected.  Not surprisingly, the AHA expects buying and managing EMRs and clinician decision support systems to be a major percentage of the added expense.

CMS has estimated it will cost an average of $1.8 million to start and sustain an ACO.  But the AHA dismisses that number as far short of the mark. Its own research, conducted by McManis Consulting, concluded that the actual startup and first-year costs for ACOs range from $11.6 million for a 200-bed, one-hospital system to $26.1 million for a 1,200 bed,  five-hospital system.

The AHA estimates that hospitals will spend anywhere from $2 million to $7 million to buy an EMR, and hundreds of thousands to integrate the system and build a health information exchange.  Not only that, health systems are likely to spend anywhere from $1.5 million to $3.9 million per year to maintain the EMR, manage the integration process and keep building out the HIE.  (My instinct is that the study’s estimates of systems integration and HIE linkages are rather low;  check out page two of the report and let me know what you think.)

If the AHA has it right — and I suspect it does — something is out of order here.  It’s hard for me to imagine how the agency could underestimate health IT costs so significantly, unless there’s some political game afoot here.

I’m not surprised to read that HIT costs are just as heavy a burden as recruiting, managing and and supporting affiliated physicians.  And I’m pretty sure that hospital CIOs aren’t kidding themselves on this front either.

Somehow, though, the Medicare folks have made some rather flawed assumptions and embedded them in the proposed  Medicare Shared Savings Program for ACOs.  If you agree that CMS is on the wrong foot here, I encourage you to submit comments on the proposed rule.  (See the beginning of the document for how to file those comments.) You have until June 6, so have at it!