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Advance for Health Information Professionals • January 2017

It’s likely that the newer value-based care models will move even further away from the original ACO approach, which will require healthcare organizations to be technologically proactive, with better integration. said that by 2018, its goal is to tie at least 50% of Medicare payments to quality or value through alternative payment models. To date, Medicare ACO programs have been the principal contributor to achieving this goal, according to a Leavitt Partners survey conducted in cooperation with the Accountable Care Learning Collaborative. Private payers are making the switch, too. While ACOs are often primarily associated with the Centers for Medicare & Medicaid Services (CMS), the majority of ACO patient lives (17.2 million of 28.3 million) are covered by private payers. Future-Proofed Technology As with any innovation in healthcare, ACOs have evolved over time— from the original Pioneer ACO Model to the Medicare Shared Savings Program (MSSP), to the Next Generation ACO Model, which includes more downside risk for providers but potentially greater rewards. Also in the mix are episodes of care (EOC), bundled payments and more. It’s likely that the newer value-based care models will move even further away from the original ACO approach, which will require healthcare organizations to be technologically proactive, with better integration. In the coming years, we will see a mix of value-based delivery and payment models on the illness-to-wellness continuum, with a mix of newer ACO models, bundled payments, full risk sharing, upside and downside risk sharing. Essentially, today’s shared-savings model— or any other alternative care model—is going to be an interim one. Therefore, the technology that enables tomorrow’s delivery and payment models must be adaptable, flexible, scalable and future-proofed so that it’s still relevant five, 10 or 20 years from now as care models continue to evolve. Here’s a sneak peek at innovative approaches that will support shared savings and other risk-bearing models of the future: • Different ways to share risk: Payers and providers will share risk, both upside and downside, in a variety of ways, and broader ways to do so may emerge. For example, there’s already been some talk about medical device manufacturers—think heart implants or stents—taking on their share of risk for cardiac patients with these devices. Clearly, automation, open-data platforms and data integration are critical to tracking patient outcomes and supporting these types of risk-sharing models. • Technology that supports many diverse data sets and real-time interactions: Population health management, at the center of shared savings and other value-based care models, has traditionally focused on chronic care and care management solutions, particularly on compliance and the delivery of evidence-based medicine. While those certainly are important considerations, the reality is that patient care is not linear, and technology will need to support the ebb and flow of the human health experience. • Providers and payers also need ready access to genomic, social, environmental and behavioral data sets to drive effective patient care plans. The right systems need to be in place to support real data sets with all of these components so that providers have the right information to achieve IHI’s Triple Aim of healthier populations, lower costs and improved patient experience and outcomes. • Proactive care models that support population health: Open-data 12 ADVANCE FOR HEALTH INFORMATION PROFESSIONALS / ACOS JANUARY 2017


Advance for Health Information Professionals • January 2017
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