At a recent HIMSS11 session on accountable care organizations packed with provider I.T. execs, the speaker asked how many were planning to be part of an ACO. Nearly all raised their hands.

If the health reform law survives its legal challenges, they'll soon have the opportunity. Medicaid and Medicare demonstration programs authorized in the law start in 2012 and several private insurers are getting ready to jump in. That said, a survey of the existing health care information technology landscape suggests many providers remain years away from having the capabilities to operate as ACOs.

The HITECH Act of 2009 was designed to position the health care industry to have the information technology infrastructure necessary to support health reform. No where is this more clear than in the I.T. capabilities needed to support ACOs, which seek to tightly coordinate patient care across the continuum of care to improve quality and population health while reducing the unsustainable annual increases in costs.

"When I think of HIT systems that have the capability currently to cross the continuum of care, Kaiser Permanente is one of the only systems that come to mind, and even Kaiser's systems have some limitations," says Marion Jenkins, CEO at QSE Technologies, an Englewood, Colo.-based systems integrator with more than 150 ambulatory I.T. implementations.

A reality check: As of January 2011, only 55 hospitals across the nation have achieved Stage 7, the highest level under the HIMSS Analytics scale of health I.T. capabilities, and 35 are Kaiser hospitals. Jim Adams, managing director at the Advisory Board Company consultancy and a former leader of HIMSS Analytics, says even Stage 7 hospitals aren't ready for ACOs.

Consequently, Jenkins warns providers to beware of I.T. vendors touting their products as fully capable today of supporting ACOs. "There's a lot of Kool-Aid getting served up."

To support ACOs in their early stages requires use of an electronic health records system developed and implemented in the past two years with more advanced support for data standards and connectivity, Jenkins contends. "The technology is available. Hardware is a tenth of what it cost a few years ago and the software is better than it's ever been."

And ACOs over time will require a lot more I.T. firepower, including pervasive connectivity, data analytics and predictive modeling technology supported with robust disease, care and utilization management applications to support care across the continuum while identifying opportunities to reduce costs. It'll take four years of ACO building to get to data analytics and five years for predictive modeling, predicts Adams.

To increase patient loyalty, ACOs also may have to consider use of personal health records and secure messaging software to tether patients closer to their primary care physician, says Bruce Haupt, vice president of business development at vendor McKesson Corp. "With an ACO, patients can switch doctors even if their doctor is accountable for their care. And the doctor may not even know about the switch. So, make it easy to interact with you."

 A story in the April issue of Health Data Management will explore how providers are gearing up for new ways to deliver and pay for care while still waiting for details.

--Joseph Goedert


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