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Moving ACOs to PCMHs through health IT

By Kyle Murphy, PhD

According to Ernst & Young’s latest annual assessment of the American providers, collaboration is increasingly redefining and revolutionizing the US healthcare industry. One particular form of collaboration the authors identify is the patient-centered medical home (PCMH), which abandons physician-centered models of care in favor of increased convenience and access for the patient.

In their summary of the emerging form of patient-centered care delivery, the authors explore the logical connection between accountable care organizations (ACOs) and PCMHs made possible through the Affordable Care Act:

Although the ACA’s ACO provisions do not directly mention medical homes, many believe primary care practices that are part of an ACO will need to adopt key PCMH features to generate savings and keep patients healthy. The PCMH can meet some of the goals of the ACO through its use of a team approach and evidence-based guidelines to deliver care, using patient data to manage population health, following up with patients after treatment and providing alternatives to costly ER or urgent care visits.

Based on a recent announcement from Beacon Health Partners, the authors’ predictions are coming true. As recently as last week, the physician-led ACO (Nassau County, NY), which participates in the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program, announced its intentions to make its 60 physician practices eligible to become recognized as PCMHs. According to the ACO’s Medical Director Jacqueline Delmont, MD, the PCMH certification process comes down to proving a physician’s or practice’s level of patient-centeredness:

Any doctor can say, “My patients have access to me.” But do they get it when they want it? Do you have after or early-morning hours? Do you allow walk-ins? Really, it goes in depth into the processes within a doctor’s office to see if the provider is trying to be more patient-centered instead of physician-centered.

A necessary component of this coordination of care is health information technology. “It’s the core, the backbone of the whole process. It could not be done without technology,” observes Delmont. Not only do electronic health records (EHR) and secure exchange allow physicians to communicate with each other to provide high-quality care at managed costs, they also facilitate communication and exchange between providers and patients.  “Most of the providers who have applied for meaningful use will have a patient portal,” Delmont continues, “And depending on physician preferences, the patient can schedule appointments, access their medical records and lab results, and communicate in some cases with the doctor through the portal in an encrypted way.”

Given the emphasis on accountability, the emergence of data analytics tools enables physicians within ACOs to evaluate not only the well-being of their patients but also their own performance. “The fact that much of information is coming in as discrete data software will allow doctors to be able to identify what are the most common conditions they care for and how their values match with overall standards and best practices in the industry,” explains Delmont. “When information coming into the doctor’s office was in paper, it was impossible to track it. Now that each activity is being registered by the software, it’s very easy to run reports on request.”

While the concepts of accountable care and medical homes were coined decades ago and have now gained prominence over the last few years, information about the financial and health benefits they provide when successfully implemented is still scarce. If ACOs are to be recognized as PCMHs and change the way care is delivered, then healthcare leaders and innovators must first tackle the challenge of getting providers to buy in.

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