Eyeing ACO horizons

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Minimum Data Set information identifying providers will be shared with health plans to fight fraud,
Minimum Data Set information identifying providers will be shared with health plans to fight fraud,

While accountable care organizations are still in the early stages of development, questions abound regarding the long-term care industry's readiness to occupy such a prominent space in the healthcare continuum. Long-term care organizations must enhance their clinical sophistication, IT infrastructure, brick-and-mortar facilities, medical device technology and support staff in order to be included in the coordinated care models, experts say. 

ACOs, created under the Affordable Care Act, are based around the concept of pooling reimbursement funds, and require an affiliation between hospitals and post-acute care providers to furnish patients with sufficient continuity of care upon discharge.

At this point, it looks like a tall order to fill, but industry analysts say it is not only possible for long-term care organizations to make these upgrades, but that it is imperative for their survival.

“It is a very serious challenge and we know what the solutions will look like, but getting there will take time,” says Jon Shankman, vice president of analytics and product management at AMC Health. “Without oversimplifying it, none of these risk entities and accountability programs will survive unless they can keep patients out of the hospital. There needs to be methods of finding out how to orchestrate appropriate care.”

Assessing analytics

When discussing such lofty topics as interoperability between healthcare providers and quantifying patient outcomes, the conversation typically turns to the value of information technology in achieving these goals. For the better part of a decade, hospitals have been investing heavily in IT infrastructure to implement electronic health records, clinical decision support systems, business intelligence and attaining “meaningful use” as outlined by the American Recovery and Reinvestment Act of 2009.

In comparison, long-term care has made little investment in IT and is not even being considered for the $20 billion in ARRA incentives. Because of this technological lag, LTC and much of the post-acute sector are fragmented and disconnected from its acute care counterparts. 

Still, IT isn't the main issue, nor should it be the top priority for post-acute care providers wanting to become part of an ACO, says Steven Littlehale, RN, executive vice president and chief clinical officer for PointRight. Instead, he believes the place to start is with analytics capability.

“As people are figuring out how to get data across the points from A to B, the challenge is not IT — the challenge is with the data you're sharing and the analytics you must have in place to win the game,” he says. “Providers need metrics to measure themselves. The IT will be there when needed — right now it is about the quality of the data.”

Hospitals aren't looking for partnerships as much as having other providers to direct, Littlehale says. Yet even though they are seen as having control over the ACO, he maintains that hospitals still have a lot to learn as well.

“They don't understand the concept of medical or non-medical co-morbidities and how it impacts someone with a chronic disease like congestive heart failure,” he says. “One nurse analyst I spoke with said, ‘We get printouts for patients we will receive, but there is no information other than the disease diagnosis.' That is the starting point — that is where we are today. Networks are being created but nothing is there.”

Teresa Chase, CEO of American HealthTech, says ACO preparedness revolves around three things: first, quality data that can be trusted; second, access to data; and finally, a strategy to share it with others. The first point has been difficult for providers, she says.

 “Innovators who bring credible data to the negotiating table with an ACO will be in a powerful position with first-mover advantage in locking up census streams,” she says.

Overall, the key for providers to succeeding in the ACO landscape is making more data-driven decisions, says Sean Riley, vice president of extended care marketing for McKesson Medical-Surgical.

“Data analytics, whether they are focused on quality, cost or satisfaction, are a very important part of that capability since they create a common language for providers in their pursuit of mutual goals,” he says. “The industry is still in the formative phase of analytics being used in this way and we see a variety of conflicting algorithms and opinions from data companies, which leads to confusion with providers.”

Ensuring data purity is paramount, notes Tina Beskie, vice president of business development and marketing for Life Systems, because “the value of analytics is only as good as the information — garbage in, garbage out.”  

The EHR factor

Littlehale's assertion that analytics must come first is an important point to consider, but Chase also contends that IT is a close second, especially with regard to implementing electronic health records and seeking interoperability.

“If you don't have an EHR strategy, you are behind,” she says. “It must be started now, even though it may seem overwhelming. Providers do not have time to waste. Interoperability is also very important … the best EHR out there won't mean much to an ACO if you can't share data with them.” 

Sharing data also matters for those working in health information exchanges, notes Cerner Extended Care Director Steve Herron. 

“By sharing resident and patient information back and forth, we will finally unlock seamless transitions of care. Imagine exporting an assessment similar to the MDS, but accurate up to the hour, that contains all the vitals and other key information about the resident that needs to be known,” he says.

For those fearing too many IT upgrades, Robert Connely, executive vice president of product and strategy for Medicity, says rapid advancements in cloud technology have made heavy investment unnecessary for long-term care.

“Five years ago, you would have spent $100,000 for the necessary technology,” he says. “But because it costs next to nothing, cloud computing has solved the investment issue.”

To date, the post-acute care sector actually has done an adequate job in beginning the process of automating patient records, says Carrie O'Connell, vice president of clinical development at Health Care Software (HCS). The next step, she says, is “to evaluate which interdisciplinary team members are not using the current EMR technology within your facility and work on getting all of them on a single, unified record.” 

For instance, she says, physicians need to be entering orders and writing their progress notes electronically, as well as storing the organization's documentation in the master resident record.

“If it's not in the record, these disciplines should at least have sign-on capabilities to be able to view the data,” O'Connell says.

To be sure, post-acute care providers need to be focusing now on adopting an IT system that allows them to share information across the continuum, says Aric Agmon, president and CEO of AOD Software.

“As an industry, long-term/post-acute care probably has about two years before they find themselves required to share this information,” he says. “Even so, it's not too early to start putting that system in place. Look for an integrated system that is certified because that means the system is able to achieve minimum government requirements for security, privacy and interoperability and is able to support the achievement results that the government expects.”

As providers look at their overall IT system and data solutions, they should remember that the ACO model also focuses on preventative care, asserts Shannon McIntyre, the director of corporate communications at Intel-GE Care Innovations. 

“Telehealth and being able to help people manage care at home, so that there are less hospital visits, may be options,” she says. “You want to keep residents engaged, and that's where technology can add a lot of value.”

An ACO future

The to-do list for a long-term care organization looking to join an ACO is long. It includes producing accurate, reliable data; developing and maintaining cogent analytics to gauge performance; finding the right IT vessel for electronic health records and interoperability; and seeking out network partners with which to work. Through a successful ACO alliance, the post-acute care provider community should be able to furnish a higher quality of care for patients at lower costs. But they first have to see if joining an ACO is right for them.

“While we would love to say ‘now's the time' for providers to take the necessary steps toward an ACO, the reality is that they are where they are and must determine first if ACOs are in their future,” says Keith M.
Farley, vice president of Prime Care Technologies. “If participation in an ACO makes sound strategic business sense, then they must identify what they are going to become and how they are going to get there.” 

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