Informedika: ACA = ACO

WHAT IS INFORMEDIKA?:

The Informedika Portal uses an ACO model to deliver free, aggregated,real-time clinical test results to the point of care in a unified view through a web portal.  

WHAT IS THE BENEFIT?:  This allows physicians to log into one portal and view “one pane of glass” for all diagnostic results including phlebotomy, pathology, radiology, and genomic testing.  The alternative is username/password login to perhaps a dozen portals as well as paper variants like fax and PDF.

HOW MUCH DOES IT COST?:  Access to the portal is free for physicians.

FREE?  THEN WHAT IS YOUR BUSINESS MODEL?:  We charge labs and other healthcare provisioners a small “pay per click” fee when physicians use our portal to requisition diagnostic tests.

SOUNDS LIKE EMR:  The Informedika Portal is not EMR or EHR but we allow diagnostic results to be exported to EMR/EHR on demand.

WHERE DO I LEARN MORE:  www.informedika.com

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What is an accountable care organization?

An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. In the new law, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

Think of it as buying a television, says Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality & Payment Reform in Pittsburgh. A TV manufacturer like Sony may contract with many suppliers to build sets. Like Sony does for TVs, Miller says, an ACO would bring together the different component parts of care for the patient – primary care, specialists, hospitals, home health care, etc. – and ensure that all of the “parts work well together.”

The problem today, Miller says, is that patients are getting each part of their health care separately. “People want to buy individual circuit boards, not a whole TV,” he says. “If we can show them that the TV works better, maybe they’ll buy it,” rather than assembling a patchwork of services themselves. “But ACOs will need to prove that the overall health care product they’re creating does work better and costs less in order to encourage patients and payers to buy it.”

When will ACOs begin operating?

The ACO initiative is scheduled to launch in January 2012, but the race to form ACOs has already begun. Hospitals, physician practices and insurers across the country, from New Hampshire to Arizona, are announcing their plans to form ACOs, not only for Medicare beneficiaries but for patients with private insurance as well. Some groups have already created what they call ACOs.

Why did Congress include ACOs in the law?

As lawmakers search for ways to reduce the national deficit, Medicare is a prime target. With baby boomers entering retirement age, the costs of the program for elderly and disabled Americans are expected to soar.

ACOs would make providers jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work they’d have to seamlessly share information. Those that save money while also meeting quality targets would keep a portion of the savings. But some providers could also be at risk of losing money.

HHS estimates that ACOs could save Medicare up to $960 million in the first three years. That’s far less than one percent of Medicare spending during that period. If the program is successful, it can be expanded by the Secretary of Health and Human Services.

How would ACOs be paid?

In Medicare’s traditional fee-for-service payment system, doctors and hospitals generally are paid more when they give patients more tests and do more procedures. That drives up costs, experts say. ACOs wouldn’t do away with fee for service but would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers would get paid more for keeping their patients healthy and out of the hospital.

If an ACO is not able to save money, it would be stuck with the costs of investments made to improve care, such as adding new nurse care managers, but would still get to keep the standard Medicare fees. The law also gives regulators the ability to devise other payment methods, which would likely ask ACOs to bear more risk. For example, an ACO could be paid a flat fee for each patient it cares for.

How would an ACO be different for patients?

Primary care doctors who are part of an ACO would be required to tell their patients. But although physicians will likely want to refer patients to hospitals and specialists within the ACO network, patients would still be free to see doctors of their choice outside the network without paying more. ACOs also will be under pressure to provide high quality care because if they don’t meet standards, they won’t get to share in any savings – and could lose their contracts.

Who’s in charge — hospitals, doctors or insurers?

Hospitals, doctors and insurers are all vying to run ACOs. Kelly Devers, a senior fellow at the nonprofit Urban Institute, explains that the question was left purposely vague in order to be flexible. “We know there are a range of provider organizations” that could manage an ACO, “but we don’t know which one is superior.”

(excerpted from Jenny Gold Kaiser Health News)

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