The Role of Healthcare Informatics in Accountable Care

Executive Summary

An accountable care organization (ACO) is a group of providers that are collectively responsible for the total cost and quality of care provided to a specific population of patients. Together, the group assumes risk and shares rewards. As with high-performing organizations in other industries, the hallmarks of ACOs are quality measurement and continuous improvement.

Like other care models that are experiencing changing reimbursement structures, ACOs require new competencies to coordinate the delivery of care, and to manage populations, finances and risk. Issues of governance, leadership and health information technology must all be addressed. Systematic IT changes may be required to build upon the implementation of electronic health records (EHR) across the community and ensure integration and interoperability.

To be successful, ACOs must excel in three broad areas where health IT plays a crucial role: clinical integration, analytics and care coordination. Without capabilities in these areas, ACOs will not be able to meet their mandate to provide quality care while controlling costs.

ACOs should carefully evaluate their technology decisions, since such choices have both strategic and tactical implications. It is unlikely that any single application or vendor can meet all of an ACO’s needs for managing risk, insurance payments, provider networks, informatics, care coordination and more. Therefore, each ACO should find a vendor that offers a strategic healthcare informatics platform along with a robust partner network that can build and connect the applications it requires. In this way, an ACO can meet its needs in the three core areas of health IT in the short term, as well as gain the flexibility and scalability to face changing accountable care requirements and address long-term strategic objectives.