CHIME Time: Lessons learned from an ACO startup

What will make accountable care organizations successful? And will they be able to succeed at all?

I'll answer that second question first based on my organization's experience. Early results from John C. Lincoln Health Network's ACO indicate a run-rate savings of 15% and reduction of hospital readmissions from 22% to 4%.

Granted, that's based only on our first year of experience, because it was only in July 2012 that the ACO began operating under the CMS' Medicare Shared Savings Program.

That first question is more difficult, and the answers will not be universal because the transition to an ACO will enable organizations to pursue a variety of approaches. It depends on the data they have available to them and their will to act on that data.

Our early success was made possible by a business strategy aimed squarely at creating value and a simple information technology strategy: leveraging existing data and information systems to the fullest extent possible. How we leveraged data exemplifies the scope of opportunities facing the industry.

For example, the secret weapon of the John C. Lincoln ACO is its transition coaches, who carefully track the progress of Medicare ACO patients. All eight are military veterans with medical service backgrounds. They are able to make good use of their specialized medical training in their jobs.

The transition coaches use JCL's integrated EHR to plan and execute their activities. The EHR alerts the coaches to hospital admissions and gives them convenient, real-time access to integrated health information spanning inpatient and ambulatory settings.

When the coaches visit patients in hospital and at home, they take wireless, encrypted laptops with them and remotely connect to the EHR. As the coaches care for their patients, the system captures progress notes and provides information at their fingertips. The data prompts the coaches to arrange care transitions, coordinate follow-up physician visits, reconcile and provide instructions on medications, conduct assessments and create care plans. Coaches can even send messages to the EHR's “In Baskets” of the patient's primary care physician.

The JCL IT team collaborated with the transition coaches to configure out-of-the-box features of the EHR to fit their care management process. A useful health information exchange is not yet available in this area, but it's possible to operate without it for now. Nearly all JCL primary care physicians and its two hospitals share a single EHR that has one record for each patient.

JCL IT staff also configured the EHR to hardwire workflows and capture data required for CMS Clinical Quality Measures, which must be reported to CMS annually. New content, such as a depression screen, was added to the system. Data were exported to Excel for semi-automated compilation of quality measures, combining data from the principle EHR with medical data sourced from other systems.

At the time of the ACO startup, the EHR lacked advanced data analytics capabilities, but it's possible to comb through its patient database using registry and reporting tools provided by the EHR vendor. New reports were developed to identify patients who most needed medical attention and to simplify the process of contacting patients to arrange health risk assessments, follow-up visits, and other interventions.

To blend CMS claims and EHR clinical data into a comprehensive database, the organization purchased analytics software-as-a-service, a tool that stratifies risk across the population; identifies care gaps based on claims and clinical data; flags patients who regularly seek care outside the Network; and assists physician leaders and care managers in developing population health programs and patient-specific interventions.

The first year of this ACO has been an adventure—and good for the health and well-being of patients. The innovative transition coach services program has delivered tangible outcomes while putting highly skilled veterans back to work. Our “keep-it-simple” IT strategy has proven itself to be valuable and we have discovered how to effectively configure the existing EHR for population health management and care coordination functions.

Looking ahead, it's clear that JCL needs to continue to innovate to make its ACO successful. Besides adding more coaches and adapting the approach to other populations, the system will be configured for new clinical quality measures, more powerful data analytics will be deployed, and organization will connect electronically with aligned community providers. These tactics will advance the IT vision of One Patient, One Record and John C. Lincoln Health Network's mission of delivering the highest quality healthcare for its community.