The ABC's of Improving Care: The Crosswalk Between PCMH, ACOs and MU
By: Dr. Sven Berg, Chief Medical Officer
WVMI/Quality Insights
As a pediatrician that had the opportunity to do my residency in an organization that pioneered many of the advances that help premature infants survive and thrive, I was introduced to the medical home concept very early in my career. In those early days, many of the infants that survived had significant handicaps that required treatment from a wide spectrum of specialists. Although we didn’t call it a medical home, our one-stop multidisciplinary clinic was just that, a knowledgeable, compassionate team of physicians and medical support personnel that established and maintained a continuous relationship with the infants and his or her family to care for the whole person. Later, as a pediatric hematologist/oncologist, I worked on similar teams of specialists, nurses and medical technicians to provide for all of the needs of my patients with cancer, sickle cell anemia and hemophilia.
A medical home is not a place, it is the way care is provided for a patient and his/her family. At its root it implies a continuous partnership with a health care team caring for the whole person, where communication occurs in an environment of trust, respect and shared decision making. Accountable care organizations (ACOs) were included in the Patient Protection and Affordable Care Act as a mechanism to advance the type of care provided in a medical home by making health care organizations accountable for providing the type care and achieving the outcomes possible in a medical home. A key tenet of accountable care is to improve integration. ACOs are expected to demonstrate, in a variety of ways, a commitment to being patient-centered and to engaging patients in managing their care and overall health. This is accomplished through implementing a wide range of managerial, legal, clinical and other leadership structures to ensure that the health and wellness of the population is managed, the most cost-effective care is provided, clinical processes are streamlined and follow the best evidence, the necessary reporting is in place, and the payments and reimbursement are appropriate.
Technology provides important tools for the health care team to make sure care is well coordinated and that all of the health needs of a patient are met. Although Meaningful Use could be considered a set of criteria that help an ACO demonstrate it is accomplishing its goals and regulatory requirements in order to increase payment now and avoid a penalty in the future, true meaningful use is the ability to use technology to improve care and provide a medical home for patients. The core processes necessary to accomplish this include:
Identifying, assessing, stratifying and selecting target populations for specific programs
Providing care management interventions for individuals and populations
Providing high-quality care across the continuum
Managing contracts and financial performance
Monitoring, predicting and improving performance
These accountable care processes require a range of IT components and capabilities. These include:
An electronic health record (EHR) that spans the continuum of care
Technologies that support engagement of patients, including personal health records (PHRs), patient portals, secure texting and social media
Care management systems that include patient and family-centered care plans, patient registries, e-prescribing, patient tracking, care coordination, transition management, disease management, population management and wellness management
Rules engines, workflow engines and intelligent displays of data that enable intelligent processes across the continuum, defined by best practices
Systems that enable interoperability between affiliated providers
Sophisticated business intelligence and analytics
The work of the Delaware Regional Extension Center, in helping organizations achieve meaningful use, is an important adjunct to organizations seeking to provide patient and family-centered care either through establishment and maintenance of a medical home or an accountable care organization.