FEATURED ARTICLES: ACO
CMS Taken To Task By OIG For EHR Fraud Failings
OIG report underscores CMS deficiencies in preventing EHR fraud, failures costing healthcare as much $250 billion each year By Christine Kern, contributing writer
Patient Security Concerns Hindering Providers
Patients are concerned about how their private information will be used and are withholding information from their healthcare providers By Katie Wike, contributing writer
Implementation Earns Hospital HIMSS Analytics Stage 7 Award
Hilo Medical Center adds paperless solutions to EHR, rewarded with Stage 7 Award by HIMSS Analytics By Wendy Grafius, contributing writer
Hospital, Outpatient Clinic Drive Patient Engagement With Patient Portal
Estes Park Medical Center selects HealthCare Anytime’s Enterprise Patient Portal citing “unique solution” and cloud platform By Wendy Grafius, contributing writer
CASE STUDIES & WHITE PAPERS
Get The Most Out Of Going Mobile: Best Practices In mHealth Implementation
Our population is becoming more mobile on a daily basis, and healthcare professionals are no exception. In fact, the very nature of the healthcare industry makes it ripe for a move to mobile. It also presents special implementation challenges.
White Paper: Becoming A Medical Home Transforming your practice into a medical home won’t require a down payment on new space – nor a remodel of the reception area. By Sage
The Path to Population Health Management: Creating An IT Foundation For A Successful ACO
Healthcare organizations across the U.S. are investing significant resources in re-architecting their care delivery infrastructures to enable them to adapt successfully to new, value-based Accountable Care Organization (ACO) payment and delivery models. As these entities prepare to go “at risk” and take outcomes-based capitated or bundled payments, they face a broad set of challenges. These challenges range from acquiring or partnering for resources that will enable them to deliver and control the full continuum of care, to understanding their new cost structures and determining if they can survive and thrive financially in an ACO world.
Swedish Reduces Transcription Costs, Achieves 100% Adoption Of EMR
This case study from Nuance takes a look at Swedish, the largest nonprofit healthcare provider in the greater Seattle Area. Swedish operates five hospital campuses, two ambulatory care centers with ERs, and a network of more than 100 specialty-care and primary care clinics.
FROM THE EDITOR'S DESK
The Problem With Consumerism In Healthcare
Many industry leaders championed a free market approach to healthcare during the 12th Annual World Health Care Congress last week. Here are a few key reasons why I don’t think this model is “the fix” our industry so desperately needs.
ABOUT ACCOUNTABLE CARE ORGANIZATIONS (ACO)
An Accountable Care Organization (ACO) utilizes a payment and care delivery system that bases payments to providers on quality metrics and seeks to reduce the total cost of care for a certain population of patients. ACOs use a range of payment models and consist of groups of coordinated healthcare providers that provide care to groups of patients. ACOs are accountable to a third-party payer and the group of patients for the appropriateness, quality, and efficiency of the health services they provide.
In 2011, the Department of Health and Human Services (DHHS) set forth initial guidelines for ACOs to be created under the Medicare Shared Savings Program. These guidelines contained all necessary steps required for a physician, health care provider, or hospital to voluntarily participate in ACOs.
The quality measures used to evaluate an ACO's performance as defined by the Center for Medicare and Medicaid Services (CMS) fall into five domains. These domains are patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.
The three stakeholders in an ACO are the providers, payers, and patients. Providers are a network of hospitals, physicians, and other healthcare professionals. The primary payer is the federal government, Medicare, but also includes other payers such as private insurances or employee-purchased insurance. The patient population of an ACO will primarily consist of Medicare beneficiaries, but in larger ACOs can also include those who are homeless and uninsured.
ACOs Face Interoperability Barriers
According to a new report, a lack of out-of-network interoperability is the biggest obstacle facing ACOs today. By Katie Wike, contributing writer