Within the recently-released final rule for the Medicare Shared Savings Program, intended to lower the risk of creating an ACO and boost participation, are a number of healthcare IT provisions.
“I think a lot of people have been holding their breath for a long time to see if there was going to be a sustainable business model that was going to come out of these rules,” says Jeffrey Spight, president of Collaborative Health Systems (CHS), which currently oversees 25 of the estimated 400 ACOs in existence. Spight also serves on the Board of Directors for the National Association of Accountable Care Organizations.
“Our opinion about it is very positive,” he tells Healthcare Dive. “We think directionally it’s going in the right place.”
Among the most talked about updates, the rule asks ACOs to submit their plans for improving care coordination through the adoption of enabling technologies. It says these may include electronic health records, tools for population health management, data aggregation and analytics, telehealth services including remote patient monitoring, health information exchange services, or other electronic tools aimed at engaging patients in their care. The new rule does not require that specific technologies be adopted.
In response to groups that call these mandates burdensome, CMS writes in the final rule that they agree that enabling technologies should be adopted thoughtfully and with the goal of improving care—not just for their own sake. “We are not finalizing additional specific requirements because we agree with commenters that ACOs should have flexibility to define their care coordination processes and use of enabling technologies,” CMS says.
Presenting a similar view, Spight says, “Everyone is talking about the same things like population health, care management, patient engagement, and risk prediction. I think these are all good things but they’re done with the notion that all providers are the same—and the truth is that from practice to practice they act very differently. My advice is the ones who are going to be successful are the ones who are going to figure out how to mold or be flexible to the different setups these providers have, as opposed to trying to get the providers to fit within their models.”
Streamlined data sharing
The new rule also aims to streamline data sharing between CMS and ACOs, in order to allow ACOs easier access to patient data to drive quality improvement and coordination or care.
The rule will do this by “expanding the kinds of beneficiary-identifiable data that will be made available to ACOs” and by “simplifying the process for beneficiaries to decline claims data sharing to reduce burden and confusion.”
Spight suggests that part of the challenge before was that it was a fairly onerous process to get patients notified and give them the chance to opt out of the data sharing. “Then you finally get your claim file back and you’re almost halfway through the first year before you have any claims data,” he says. “Now, being able to get that quicker and easier is certainly going to be helpful.”
What wasn’t included
The final rule is also interesting for what it didn’t contain: the previously-proposed telemedicine waivers for ACOs in Track 1. It notes that such waivers can be expected to begin “as early as 2017.” In the meantime, CMS says it will consider telemedicine waivers from ACOs in two-sided risk models and in Track 3.
Spight says it was surprising and disappointing that CMS didn’t move to incorporate telemedicine waivers for Track 1 this time around.
“There are lots of great, innovative companies and programs out there being built around providing primary care access in different ways, and telemedicine was a key part of that,” he says.
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