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As the healthcare landscape continues to evolve, and more Accountable Care Organizations (ACO) come together, the need for cohesion and interoperability is increasing. Often, the physicians and hospitals within these organizations will have different EHR systems, creating quite a few areas of difficulty when trying to connect them all seamlessly. A Community Connect program can help.

CMS defines an ACO as a group of doctors, hospitals, and other health care providers, who voluntarily come together to provide coordinated, high-quality care to their Medicare patients. Medicare first established ACOs; however, we are now seeing private payers contracting with ACOs. One of the primary benefits of an ACO is that it allows for contracts with payers; designating that a team of caregivers will provide coordinated patient care across the healthcare continuum. The goal is to manage patient populations, improve patient care coordination, enhance preventive care, and eliminate unnecessary and duplicative costs to patients.

A Community Connect program is a strategic collaboration between healthcare organizations and community physicians and hospitals and is an effective way to integrate these groups into an overall electronic health record (EHR). To understand how a Community Connect program can help ACOs, it is first essential to understand some of the difficulties facing these organizations when trying to communicate with each other.

Data Usage

ACOs and value-based care are here to stay. However, it has become challenging for ACOs to capture the necessary data and get the right data in the hands of the providers. One of the most obvious hurdles is the number of different EHRs that ACOs are documenting in today. Having different kinds of software makes it challenging to get the provider a clear picture of the patient’s previous care in a timely manner. To alleviate these issues, ACOs are taking on the financial burden of creating interfaces, known as Application Programming Interfaces (APIs). APIs are the messenger that delivers a request to the EHR that is requested and then delivers the response back to the requesting system. EHR vendors have developed proprietary APIs independently of each other, and functionality is often different. Some allow for read-only data, while others allow for discrete data.  Having to evaluate each vendor is tedious and time-consuming and creates a significant hurdle when it comes to interoperability.

Interoperability

Interoperability is necessary. CMS requires ACO members to use the 2015 certified EHR technology (CEHRT). ACOs are working with Health Information Exchanges (HIE) but still don’t always get the necessary patient data, requiring manual interaction via phone or fax. Healthcare organizations participating in one or more ACOs are looking to one EHR software solution to avoid the need for this manual intervention. Similarly, many ACOs are requiring members to move to one EHR solution. Although this can be an adjustment and an initial cost burden for both the members and the organization, one platform allows ACOs to standardize workflows and increase control over ACO operations. When everything is standardized, community providers can receive patient data from a care team immediately without having to go through the HIE. Scheduling for consults also becomes streamlined and registries and preventative care profit from utilizing one system.

Costs

Some large healthcare systems are extending their existing EHR to ACO members under the Stark Law exemption. This gives smaller practices an affordable or sometimes free (via ACO waiver) way to implement an EHR system and be interoperable with the larger healthcare system. A designated healthcare organization can donate up to 85% of the cost of the EHR software. This is a cost to the organization, but the benefits of sharing data seamlessly, having one software platform for reporting, and providing better patient care makes it worthwhile. There is also an opportunity for the government to fund/grants for extending to federally qualified health centers.

A question that arises from Stark Law and the Anti-Kickback statute is patient referrals outside of the ACO. Providers participating in the ACO are going to be more likely to refer their patients to the same providers and hospitals within the ACO they participate. Therefore, the government is going to have to address this possible conflict if they expect providers to manage patients under the authority of the ACO.

Developing a Community Connect program can help address the issues stated above. Again, a Community Connect program is a strategic collaboration between healthcare organizations and community physicians and hospitals and is an effective way to integrate these groups into an overall electronic health record (EHR). For this program to be effective, it does take a financial commitment and appropriate personnel resources from the health system. Most organizations are well-versed in training and implementations but are not prepared to become a vendor. Pre-program work such as governance, contracting, policies/SOPs, communication, pricing models, and team structure are a few key areas that need to be focused on prior to the first installation. Once these are in place, Community Connect can be a turn-key solution, connecting ACO members through technology and creating a better experience for the provider and patient.

In a recent KLAS Research report, Epic implementations among small size healthcare practices appear to be increasing as more practices join local accountable care organizations and affiliate with other organizations that use Epic. KLAS compiled performance ratings from small practices, comprised of only one to 10 physicians, for Epic’s Community Connect EMR.

Here’s how the participating organizations ranked Epic Community Connect on a 100-point scale:

  • 93% said that Epic Community Connect is part of their organization’s long-term plans.
  • 93% said they would purchase the EHR software again.
  • 86% said the EHR software keeps all of its promises.

If you are interested in learning more about Optimum’s Community Connect Workshop, please click here.

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