Care coordination matters, even if you're not on ACO track

Even in the midst of battling skeptics and supporters of accountable care organizations (ACO), care coordination is one trend that everyone could get on the bandwagon for. Whether or not you're thinking about joining an ACO, preparing for care coordination is one of those "no brainers" that should start today. It not only benefits the patients but also can help your hospital or health system stay ahead of the curve.

FierceHealthcare caught up with Dr. Brian Yeaman, chief medical informatics officer of Norman (Okla.) Regional Health System to hear what he had to say about why hospitals and other health organizations are moving toward coordinating care across the continuum.

Norman Regional, a three-hospital system with nearly 500 beds, is currently testing meaningful use. Two years ago, it ramped up its electronic health records and health exchange information system, embedded clinical decision support of preventive measures and evidence-based medicine into its platforms, and began using longitudinal order sets. Like many organizations across the country, the organization is trying to better coordinate care for its patients. Even though Normal Regional elected not to participate in the Pioneer ACO Model, it is currently considering participating in the next class of ACOs, the Medicare Shared Savings Program.

Challenged much? Coordinating care hurdles
The biggest hurdle to coordinating care is tackling the operations and infrastructure--no small feat.

"It's a profound workflow challenge," said Yeaman. "Just understanding how to implement the tools and implement the workflow changes are some things that even the largest health systems in the country have struggled with."

Even under the Pioneer ACO model, organizations face significant operational challenges (not to mention costs) to create the manpower of physicians, nurses, clinics, home health, and hospice care that fuels managing chronic conditions between the various parties.

Organizations also must consider meaningful use requirements and electronic health records, all of which require the support of providers who ultimately will be using them. 

"As a provider, trying to take care of patients ... all of the workflow changes that we're having to accommodate in terms of ICD-10 coming down the pike--in terms of electronic health records and meaningful use--and then implementing all of these quality measures and how we enter that data, it's absolutely overwhelming," said Yeaman. "You can rapidly feel like your caring for a computer more than you are a patient."

To help ease the transition, Yeaman suggested institutions strongly consider supporting providers with the education and training they need to carry out those workflow changes.

ACO or no-go?
When asked what went into the decision making process to join the ACO Pioneer program, Yeaman said that the risk was a big factor in declining to join this time around.

"We are still operationalizing all of the quality pieces. The condition management pieces are going to be a significant risk when budgets are extremely tight to actually see the needle move on quality and readmission and get that reimbursement. And even in that point and time, we're not certain that the reimbursement is enough to cover the operational costs at this time."

Fortunately, the Centers for Medicare & Medicaid Services has yet to mandate ACO participation; organizations are still left to decide whether they wish to participate on an individual basis. However, that doesn't mean that everyone in the organization is on board with the executive decision to partake or forgo.

Culture is key
The last piece to coordinating care is, of course, culture.

"Just because you set up infrastructure and systems doesn't mean they are being used adequately or appropriately. It takes time to change your culture," Yeaman said. "To truly impact outcomes, measurement alone and resources alone are not enough. You have to permeate your entire health system from top to bottom with this culture change in order to truly move the mark on care."

Yeaman also warned organizations to implement operational workflow changes carefully--be it the ACO pioneers or the undecided hospitals--and to proceed with caution.

"If we push this too far, too fast, we've got a potential to create just as many errors if not more than we're currently creating. We've got to go about this in a wise and careful process," he said.

In the end, organizations will decide for themselves whether they will join the ranks of the Pioneers, the Shared Savings ACOs, or check the "no thank you" box. Likewise, they will have to decide for themselves how they want to share workflows and leverage tools that make sense for them.

"We're going to have to become tighter aligned and communicate more across the health systems then we ever have before in terms of getting together to figure out how to adapt to this new environment."

Like it or not, organizations are moving toward massive coordinated care, which doesn't have to be a scary thing. - Karen