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ACO Success Requires Taking Health IT to Next Level


Moving from fee-for-service to value-based reimbursement is no easy task. Leveraging health IT, the right way, can help.

Health IT can help physicians improve the quality of care they provide patients; it can also help physicians identify and prevent potential patient health problems from occurring; it can even help them do these things while reducing healthcare spending. The trick, however, is that to do all of these things, providers need to leverage technology in the right ways.

That’s according to internal medicine physician Charles Kennedy, CEO of Aetna

Accountable Care Solutions, which collaborates with and assists providers with transitioning to accountable care organizations (ACOs). ACOs are groups of providers (practices, medical groups, hospitals) that partner up to improve care quality while reducing care costs. If successful, providers share in the cost savings.

During his session at the HIMSS13 Conference in New Orleans, “Lessons/Insights from a Pioneer ACO’s Journey to Value-Based Care,” Kennedy said that for health systems to provide high-value care (improved care quality at reduced care costs), they need to move beyond using EHRs to document patient information and begin using them in a more “proactive” manner. For instance, using EHRs to determine which patients are behind on medication refills, and which are going to the emergency room repeatedly.

“When you begin to look at technology not from the perspective of documentation but from the perspective of problem solving, solving these types of problems, you begin to move in a very different direction,” said Kennedy, who co-presented with emergency medicine physician Tricia Nguyen, chief medical officer of Phoenix, Ariz., -based Banner Health Network, a large health system that is one of the 32 ACO pioneers, and is also participating in an ACO arrangement with Aetna. In fact, Aetna is providing Banner with full technology support for population health management to help it succeed as an ACO.

“It’s important to have your data be electronic, but just having your data electronic through an [EHR] is insufficient to have success in an ACO world and provide the kind of quality care that we all want to ... provide to our customers,” said Kennedy, noting that even when all the relevant information is available in the EHR, its difficult for physicians to sift through all of it and identify certain health issues or potential issues that could improve patient care during a patient’s visit. “That’s part of the challenge, once you mobilize the information, how do you find it?” said Kennedy.  

Part of the way Aetna is helping Banner Health meet that challenge, he said, is by leveraging technology to merge clinical data and claims data and then feeding that information back to physicians in a timely and relevant way. It’s also using an analytics tool to identify gaps in care, and when gaps are identified, it alerts doctors and other members of the care team so that the care provided is more consistent with the evidence base. “We’re day by day building that infrastructure to allow this next generation of health IT to occur,” said Kennedy.

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