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What’s Ahead – CMS Issues New Rules for Accountable Care Organizations (ACOs)

April 2, 2011

by Mansoor Khan, Sc.D. 

On March 31, The Centers for Medicare & Medicaid Services (CMS) proposed new regulations for Accountable Care Organizations (ACOs). While they are complex – and in excess of 400 pages in length – DiagnosisOne offers a solution to help healthcare organizations that are seeking to form an ACO while adhering to these proposed guidelines.

CMS has gotten many things right in these rules. We at DiagnosisOne are heartened that throughout the proposed regulations, the core concepts of evidence-based medicine, clinical decision support, continuous improvement and accountability are emphasized.

In our opinion, the key concept here is Continuous Quality Improvement. Continuous Quality Improvement requires organizations to finally close the loop on the care process. The type of Continuous Quality Improvement envisioned in the ACO model requires comprehensive clinical decision support (CDS) at the point of care combined with population-, practice-, provider- and patient-level reporting to determine whether the outcomes needed by an ACO to reach its goals are being achieved. This means that the organization must be able to provide guidance to all care providers (hospital-based, ambulatory, or home-based) at the point of care, and then evaluate whether that guidance resulted in the desired outcomes. If the outcomes are not achieved, then the organization must be able to very quickly modify the guidance and deliver it to the point of care.

The CDS and analytics platform must support these clinical and administrative needs of an ACO seamlessly. This means that the CDS and analytics must be based on one evidence-based platform that satisfies multiple stakeholders, at many touch points in the care process.

Dressing up static order sets and adding a few hard-coded rules cannot be called Clinical Decision Support anymore. To meet the numerous requirements of delivering effective care, engaging patients and continuously improving processes, organizations will need to deploy multi-parameter, real-time decision support that contains a large library of evidence-based content that is truly integrated with both population management analytics and analytics showing the financial impact of discrete clinical events. Only when all these technologies are integrated on a Web services based platform that is also able to process the clinical document architecture, will our health system reap the benefits of Accountable Care.

To create truly effective ACOs, organizations will need not only a solid IT infrastructure but they will need the right kind of infrastructure. 

Fortunately, a new generation of companies led by DiagnosisOne is now deploying systems that provide these capabilities. DiagnosisOne offers providers the ability to adopt a step-wise, flexible strategy for the introduction of ACO-enabling technology.  Our multi-level clinical analytics and real-time, scalable, point-of-care CDS modules leverage a library of over 25,000 evidence-based rules to achieve Continuous Quality Improvement and accountability. DiagnosisOne offers the only solution that completes the loop of providing point of care clinical decision support and tying the results back with clinical analytics.

We plan to provide additional guidance and commentary on the significance of the proposed ACO rules over the coming weeks, and look forward to delivering continued innovation to our hospital, payor and EMR clients on new methods to ensure each care encounter is as informed as possible, and each health system leader has the information required to design effective health improvement strategies. As the ACO model continues to gain momentum in the market, we will be there to give providers these capabilities so they will be uniquely positioned to reap the financial windfalls associated with consistently providing evidence-driven, informed care.

In the meantime, we encourage hospitals and Independent Physician Associations (IPAs) to view our recently published whitepaper, Clinical IT Requirements for ACOs, Enabling Effective Patient & Population Management to get a clear roadmap on what is required to excel under this new reimbursement paradigm.

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