The creation of Accountable Care Organizations (ACO) is becoming a priority in healthcare as the Centers for Medicare and Medicaid Services (CMS) finalizes the rules for participating in the Medicare Shared Savings program. The focus on coordinated care is aimed at encouraging providers to create a patient-centered circle of care so that all providers, whether they are hospitals, specialty groups, or individuals, can share patient health information efficiently and provide better care at a lower cost than before. To achieve shared savings and receive the full reward payments possible, the ACOs will be required to meet 65 specific performance thresholds.
Soon after acceptance by CMS, ACOs will be assigned specific Medicare patients. At this point, caregivers are anticipated to have a spectrum of tools at their disposal to be able to handle care coordination of their patient population. The success of the Accountable Care delivery system depends on the quality and efficiency of communication within that circle of care built around each individual patient. To achieve that improvement in care and cost-savings, the participating providers need to have access to a consolidated single view of the patient and their health information.
Core to this single view is an Enterprise Master Patient Index (EMPI), but equally important given the landscape of providers providing the care is a Provider Registry and Directory.
An EMPI automatically matches and indexes patient information from the heterogeneous registration, admitting, and other patient management systems. Some organizations may seek the nirvana of a single patient management system, but few if any are able to achieve this, and an ACO in particular, with the variety of participating providers, is highly unlikely to be in such a position. Without an EMPI, it is impossible to obtain that single view and bear the fruit that results from it.
Taking the next step in establishing the circle of care, a Provider Registry is the comprehensive and trusted master registry of all information about providers and the services they are authorized to deliver. The registry maintains core demographic information, including license and credential status, relationships between entities and roles, and multiple work locations. Further, a Provider Registry coupled with an EMPI enables the creation and management of all of the relationships between a patient and their providers. With the ability to link provider records together and create relationships to patients, the circle of care will begin to take shape around that patient. It is impossible to envision an ACO without these tools.
With an EMPI and Provider Registry, Care Coordinators will be able to search and link up to other specialists and caregivers depending on their assignees needs, and manage the relationships between a patient and their caregivers. Access to these resources will lead to fewer medical mistakes, improved coordination, elimination of duplicate or unnecessary tests, and a better overall care experience for the patient. The reductions in expenses and increase in quality care due to this streamlining will translate into powerful actionable intelligence that an ACO will then report to CMS to meet the 65 quality measures.
When coupled with a portal, patients are able to easily view and comment on these relationships. This level of patient-empowerment and inclusion supports the pressure being put on the healthcare community to educate and bring the patient into the decision-making process so they can actively participate in their own health care delivery. This also provides a solution to some of the requirements CMS has put on patient-involvement to improve the quality of the care experience.
ACOs that are connected at this level will be in the most advantageous position when they are assigned their Medicare patients. The CMS and the participating Federal Agencies will view them in a preferable light when the application window opens in January 2012. As potential ACOs gear up for the application process, participating members, whether they are hospitals, specialty groups, or individual health professionals providers, will need to cross-reference their databases and flush out duplicates and other disparities to gain a clear picture of their patient population as well as their practicing doctors and staff.
While potential ACOs today are moving forward with their strategies, the need for an EMPI is being accepted by all as the most important steps to creating a crucial panoramic view of their patients’ medical status and history. There is no alternative solution that does a better job and is more capable at supporting the monumental task of linking millions of records across multiple sources than NextGate’s MatchMetrix EMPI. An EMPI will be the cornerstone of every ACO’s success given the guidelines proposed by CMS. The sooner this is understood and the sooner preemptive action is taken to invest in an EMPI, the better positioned an ACO will be in 2012.
To learn more about NextGate’s offerings, check out our EMPI and Provider Registry sections of our web-site.
