I was reading “2011 Predictions: MU Goes Tactical, ACO Strategic” where John Moore, Chilmark Research, lists 2011 key IT healthcare trends. I have a payer background so my view of ACOs is slanted to the systems and processes that have been put in place over the years at Payers (DM, CM, UM, Wellness, Pharmacy Benefit Managers, Member Portals, Employer Portals, Underwriting, Risk Management, Regulatory, Product Roll-outs, Provider Contracting, Broker Contracting, Member Communications, Employer Communications, Claims, Eligibility, etc., etc., etc.)
I cannot help but stop and think… an ACO needs a Payer as a Partner… why spend all the IT money, organization build up, and headaches to do what Payers have been doing for years. If I were an ACO, I would partner with a Payer for all of these services, systems, applications (care management being top with work flow not just EHR data input), BI, and not build or manage it myself… that is right… I would outsource ITand organizational processes to the Payer. The environment today is the right balance… Providers/Medical Homes (not Payers) have the responsibility and savings drivers to lower health care costs which allows the Payers to control premium increases with Employers /Members. ACOs can save on costs by outsourcing IT to Payers for services and systems. “Is this why large Payers are acquiring HIE/EHR vendors?” Why build an HIE/EHR if you can tap it as a service through a Payer?
I may be way off, but a review of John’s 2011 Predictions has lead me to think I may not be to far off. Predications leaning to ACO/Payer Partnership include his 2) C-Suite Strategy Focuses on New Payment Methods, 3) RCM & Charge Capture Systems Require Overhaul, 4) Mergers & Acquisitions Continue Unabated, 9) Analytics & Business Intelligence Perceived as Nirvana, and 11) The Buzz at HIMSS’s11? Everything ACO!.
To learn about how these partnerships and/or contracts are going to flow and gain an insight of work flow to BI system requirements (which Payers can provider to ACOs), I would suggest reading “Private-Payer Innovation In Massachusetts: “The Alternative Quality Contract“”, by Michael E. Chernew, Robert E. Mechanic, Bruce E. Landon, and Dana Gelb Safran, Health Affairs 30, No. 1 (2011): 51 – 61. They describe the arrangement with BCBS of MA and Providers (i.e., ACO early adopters) that exemplified the type of experimentation encouraged by the Affordable Care Act and describe the unique contract and overcoming pervious hurdles encountered by other global-payment methods.
Finally, who is going to afford and share in costs for the innovative work and systems that could bring ACO/Providers and Payers on an integrated platform to avoid duplication of systems and organization functions? I suggest ACO and Payers partner for such innovative systems. See the Premier, Inc., January 2011, Press Release, “IBM and the Premier healthcare alliance to integrate nation’s healthcare data to gain insight, measure performance and improve population health. Industry-first data sharing model among hospitals, doctors and outpatient clinics to support accountable care and performance improvements“.
