Recent federal legislative and regulatory efforts to incentivize new approaches to improving both the quality and efficiency of healthcare delivery are catching on across a range of healthcare organizations. Community health centers are watching closely as they seek to understand the implications of the proposed rule on Accountable Care Organizations (ACOs) and other new developments
The Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” (sponsored in part by the RCHN Community Health Foundation) convened a well- attended lunch briefing session on April 6 to coincide with the release of draft CMS rules for ACOs . (Program materials, presentations and video link available at www.e-healthpolicy.org)
At the briefing, U.S. Senator Sheldon Whitehouse (D-R.I.) Honorary Steering Committee Co-Chair commented that: “ACOs have generated a great deal of buzz with the release of rules and most realize that health technology will be the framework for this new model of care”.
Participants from different parts of the healthcare sector offered their perspectives on the challenges and opportunities facing the field under Medicare shared savings efforts:
- Susan M. Christensen, Senior Public Policy Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC moderated the program and offered that the Individual Health Record will ultimately integrate all clinical and financial data on a regional basis, and in the process, form our understanding of the “single best record”.
- Lisa Harvey-McPherson, Vice President, Eastern Maine Homecare System — which won the HIMSS 2008 Nicholas E. Davies award for Organizational excellence — discussed collaborative efforts across a range of hospitals, nursing homes, and homecare organizations to extend longitudinal care using telehealth, patient-centered systems, and outcomes-based results to transform clinical care. Eastern Maine, which is designated as an ONC Beacon Community program, is also to serve as a national model for collaboration..
- Pamela Friedman, Vice President, Strategy and Governance, Ingenix, Inc., a subsidiary of United Healthcare, reported that Igenix is working with thousands of healthcare organizations on five critical success factors toward achieving ACO status: organization/structure; aligning incentives; clinical transformation; technology and infrastructure; and analytics and measurement. Ingenix would like to take the ACO concept further by promoting “sustainable health communities” where all participants function in harmony.
- Martin Lustick, M.D., Corporate Medical Director, Excellus BlueCross BlueShield, is working in nine Rochester, N.Y – area counties with a subscriber base of 1.2 million patients, including those served at several community health centers , to connect clinical results, establish a Rochester Medical Home Initiative, and promote enhanced performance measures toward better claims data integration.
- Keith Figlioli, Senior Vice President of Informatics, Premier Healthcare Alliance discussed an approach using the nations’ largest clinical/operational/supply chain database that has already helped achieve over $1.4 billion in savings just in 2010. Premier’s approach to “high-value” healthcare envisions groups of providers willing and capable of accepting accountability for the total cost and quality of care for defined populations. Core components are: patient centered; medical home oriented, high-value oriented; and include robust ACO leadership and payor partnerships.
Meanwhile, community health centers and primary care associations across the nation are working to establish various structured alliances similar to those called for in the draft ACO regulations (even if they may not qualify immediately as participants in shared savings under proposed DHHS regulations) as well as under the new Center for Medicare and Medicaid Initiative (CMMI) for medical home models.
Last December, CMMI announced the FQHC “Advanced Primary Care Practice Demonstration” that will test the medical home model in up to 500 community health centers serving low-income Medicare patients. Additionally, eight states have now joined a“Multi-Payer Advanced Primary Care Demonstration”, launched last June, to evaluate the effectiveness of the patient-centered medical home model for Medicare, Medicaid and privately insured patients.