Proposed ACO Rule A Change for Delivery System Transformation

Dr. Farzad Mostashari | April 1, 2011

Yesterday’s release of the notice of proposed rulemaking for Accountable Care Organizations (ACOs) is another reminder of the synergies to be found in the meaningful use of health information technology (health IT) and delivery system transformation. Because health IT tools are an essential foundation to support the kinds of coordinated, patient-centered, and accountable care envisioned by the ACO program, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) have been working closely to align our policies and programs in the development of this proposed rule.Under the proposed rule, ACOs will create incentives for better communications among health care providers regarding the patients under their care, will require clinicians to measure and improve their performance, and improve the care experience for patients navigating today’s fragmented health care system. As described in a recent report  published by the Patient-Centered Primary Care Collaborative, Health IT adoption, and changes to payment structures are both necessary to drive major delivery system reform.

The proposed rule’s desired outcomes are the three-part aims of better care for individuals, better health for populations, and slower growth in costs, and refers to required processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care. These goals and processes are closely aligned with the EHR Incentive Program’s framework of Meaningful Use objectives. In the proposed rule, fifty percent of the primary care providers of Accountable Care Organizations need to be meaningful users by the second year of the ACO contract (pg. 220).  CMS is also seeking comment on a similar requirement for hospitals in the proposed rule.

Improved performance measurement through information technology is an especially critical element in the transformation and improvement of care delivery systems. As providers and hospitals adopt and implement certified EHR technologies, the ability to measure and improve the quality of care along multiple dimensions while reducing the burden on providers will be critical. There is large overlap between the clinical quality measures used in the EHR Incentive Program and in the proposed ACO rule, and the proposed rule strongly signals a desire for even greater alignment of the reporting requirements for ACOs and Meaningful Use, including through eventual reporting of clinical quality measures directly from EHRs (pg. 200-201).

Several of our Beacon Communities and HIE Challenge Grant awardees are building on the building blocks for health information exchange established through our standards and interoperability activities to ensure seamless care transitions for patients as they move from one care setting to another. These same approaches will be fundamental for ACOs aspiring to coordinate care, lower costs, and improve outcomes. Consistent with ONC’s vision and efforts to promote health information exchange, information will need to follow the patient wherever they seek care, inside or outside the ACO. Indeed, the rule proposes that ACOs creating data “lock-in” by limiting or blocking this information flow risk having their ACO agreements terminated (pg. 321).

The proposed rule’s vision regarding patients goes beyond patient-centeredness as an approach for providers to include patients as full partners in the care team. In support of that aim, it calls for patient access to both medical records and evidence-based data, enabling informed decision-making by patients and their caregivers/family members. Care must also be tailored according to individual patients’ unique needs, preferences, and priorities. The rule proposes that patients be afforded “meaningful choice” and the ability to opt out of CMS sharing of certain claims information with ACOs and envisions the process of informing patients of this choice as being an excellent opportunity for providers to forge a positive relationship with each beneficiary.

ONC’s mission is to improve the nation’s health by fostering better communication and coordination through the use of health IT. And ONC will continue to work with CMS in its development of innovative payment and delivery reforms like ACOs to improve the nation’s health by fostering better communication and coordination. In many ways, the proposed ACO rule represents a new and important convergence of how health IT can be used to support delivery system reform.

We encourage everyone who has interest in these goals to review the proposed rule and become a participant in the process by providing comments during the 60-day comment period. We look forward to hearing back from you.