How Accountable Care Organizations Rely on Electronic Health Records to Succeed

The Critical Role of EHRs in Driving Quality and Value for ACOs

Accountable care organizations (ACOs) depend on electronic health records (EHRs) to better coordinate patient care between different healthcare providers. EHRs allow ACOs to share important health data electronically so they can work together to improve care quality and lower costs.

Over the past decade, accountable care organizations (ACOs) have become an increasingly popular model for healthcare delivery in the United States. ACOs bring together groups of providers to coordinate care for a defined patient population with the goals of improving quality and reducing costs. As of 2018, over 1,000 ACOs were serving more than 32 million patients across the country.

A key tool that ACOs leverage to achieve their objectives is the electronic health record (EHR). EHRs are digital versions of patient medical histories that provide real-time, patient-centered records to authorized users. They contain notes from doctors, test results, imaging scans, treatment plans, and other important health information.

EHRs are essential for ACOs to improve population health management, enhance care coordination, reduce costs, and succeed with value-based reimbursement approaches. 

Brief Overview of Accountable Care Organizations

The ACO model was formalized under the Affordable Care Act in 2010 to realign provider incentives towards value-based care. ACOs bring together physicians, hospitals, and other providers to collectively care for a group of patients with a focus on coordination to improve health outcomes and control costs. They may also partner with private insurers.

ACOs take on financial risk related to the health outcomes and expenses for a population. If they keep costs below a set benchmark while meeting quality standards, they share in the savings as an incentive. This shifts the focus from volume to value.

Core goals of ACOs include:

1	Enhanced Care Coordination	ACOs aim to improve the integration and coordination of care among providers.
2	Improved Population Health Outcomes	The model seeks to enhance the overall health of the population served.
3	Cost Reduction	ACOs strive to minimize unnecessary services and eliminate redundancy in care delivery.
4	Value-Based Payment Models	They promote a transition from traditional fee-for-service models to value-based payment systems.

Key participants in ACOs include primary care providers, specialists, and hospitals. They use team-based approaches to provide comprehensive and integrated care.

What are Electronic Health Records?

Electronic health records are longitudinal digital records that provide timely, readily-available, and comprehensive patient health information to authorized healthcare providers. They contain medical and treatment histories, test results, notes, images, current medications, allergies, immunizations, and other medical data.

EHRs replace paper-based medical records to create a cohesive record system with enhanced accessibility. Providers can securely share electronic records across organizations and systems to coordinate care. Patients also have access to view their records and share them securely.

The Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 allocated over $35 billion to incentivize EHR adoption. As of 2021, nearly 9 in 10 (88%) of U.S. office-based physicians adopted any electronic health record (EHR) system, and nearly 4 in 5 (78%) had adopted a certified EHR system.

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EHRs Provide Critical Support for Achieving ACO Goals

EHRs are foundational technologies for ACOs to improve population health, enhance care experiences, and reduce costs. Access to complete, timely data is essential for coordinated care and performance measurement. 

Specific ways EHRs align with core ACO objectives include:

1. Enhanced Care Coordination

Electronic health records facilitate better coordination of care across providers and care settings. Providers can instantly view longitudinal patient records across the entire care continuum, improving clinical decision making and care transitions. 

Secure messaging within EHR systems also allows streamlined communication between providers, replacing telephone and fax. Furthermore, EHRs enable seamless data sharing as patients transfer between various facilities including hospitals, specialists, rehab centers, home health services, and more.

Population Health Management

Population health tools in electronic health records allow providers to proactively manage the health of entire patient groups. Integrated data helps identify patients needing preventive or chronic disease management. 

Robust analytics also help understand health trends and disparities, enabling the creation of targeted care programs. Additionally, comprehensive data facilitates monitoring success on quality benchmarks for the overall patient population.

Cost Reduction

Electronic health records can help reduce waste and lower costs in several ways. Viewing comprehensive records avoids duplicate procedures and unnecessary tests. E-prescribing and drug interaction alerts also improve prescribing practices to reduce adverse events. Moreover, data analysis identifies opportunities to eliminate waste and lower costs by tracking utilization patterns.

The Role of EHRs in Care Coordination

Care coordination is a critical focus area for ACOs to improve quality and patient experiences. EHRs facilitate coordination across disparate provider teams and sites of care.

• EHRs Facilitate Care Coordination: EHRs play a critical role in enabling care coordination across disparate provider teams and care settings within ACOs. Access to comprehensive patient data through shared records helps prevent fragmentation and allows all members of the care team to stay informed about the patient's health history.
• Streamlined Referrals and Messaging: EHRs facilitate streamlined specialist referrals by integrating patient records. Direct messaging capabilities within EHR systems replace outdated communication methods like faxes and phone calls, improving efficiency.
• Transition of Care Notifications: EHRs can provide care transition notifications to alert providers when patients receive care elsewhere, such as in emergency departments or post-acute care facilities. This helps providers stay updated on treatment plans and coordinate care accordingly.
• Remote Patient Monitoring Integration: EHRs can integrate data from connected devices used for remote patient monitoring, allowing providers to access real-time health data and make informed decisions about patient care.

With robust information exchange through EHRs, providers can seamlessly collaborate to align care.

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Using EHRs for Population Health Management

Population health tools allow providers to proactively manage the health of entire patient groups. Main features include:

• Chronic Condition Registries: EHRs enable the creation of registries that help identify and monitor patients with chronic conditions, facilitating timely interventions. This is essential for managing chronic diseases effectively.
• Identifying Care Gaps: Through data analysis, EHRs can identify gaps in care, which supports outreach programs aimed at improving compliance with preventive care measures. This proactive approach is crucial for enhancing patient outcomes.
• Trend Analysis: EHRs provide tools for trend analysis, offering insights into community health needs and disparities. This information is vital for guiding resource allocation and ensuring that interventions are targeted where they are most needed.
• Risk Stratification: EHRs allow for risk stratification, which segments populations to identify high-need patients. This enables healthcare providers to develop customized care plans tailored to the specific needs of different patient groups.
• Quality Measurement: EHR data is used to evaluate performance on health outcome metrics, optimizing quality measurement. This is important for ACOs to track their effectiveness and improve care delivery.

With comprehensive data analytics, ACOs can implement targeted initiatives to keep patient populations healthy.

EHRs and Cost Reduction

Electronic health records can help reduce waste and lower costs through the following mechanisms:

• Optimizing Medication Management: EHRs enhance medication management through e-prescribing and drug interaction checking, which improves adherence and reduces complications. Studies indicate that EHRs can significantly reduce adverse drug events, thereby lowering costs associated with medication errors and complications.
• Reducing Duplicate Testing: By providing comprehensive access to patient records, EHRs help prevent unnecessary duplicate tests. This capability is crucial for minimizing waste and improving efficiency in healthcare delivery.
• Improving Preventive Care: EHRs facilitate alerts and reminders for preventive care activities, such as cancer screenings and vaccinations. This proactive approach can lead to better health outcomes and reduce long-term healthcare costs by managing chronic diseases effectively.
• Enabling Performance Improvement: Data analysis capabilities within EHRs allow for the identification of variations in clinical practices and costs. This information can be used to minimize wasteful care delivery and optimize resource utilization, contributing to overall cost reduction.
• Facilitating Value-Based Contracts: EHRs support the implementation of value-based reimbursement models by providing quality metrics and utilization data. This alignment with value-based care approaches helps ensure that healthcare providers are rewarded for delivering high-quality care rather than the volume of services.

Through data analysis and decision-support tools, EHRs provide critical infrastructure for ACOs to cut costs.

Overcoming EHR Implementation Challenges

While EHR adoption has increased rapidly, ACOs face challenges in effectively leveraging these tools:

Interoperability 

A lack of data exchange standards and differences between EHR systems from various vendors constrain effective care coordination between providers. Patients often receive care from multiple unaffiliated providers using different EHRs that cannot share data seamlessly. This hampers efforts to coordinate care, track treatment histories, and monitor patient outcomes across sites of care. To improve this area, make sure to:

• Adopt national interoperability standards like FHIR to enable better data exchange between disparate EHR systems.
• Use health information exchanges (HIEs) to facilitate centralized data sharing between providers on different systems.
• Integrate APIs and other interfaces to allow third-party apps to pull relevant data from multiple EHRs.

Privacy and Security

Protecting sensitive patient data and meeting complex regulatory requirements around data security and privacy proves difficult with multiple EHR systems. EHR implementations must have strong access controls, encryption, and other security measures to safeguard protected health information while still allowing appropriate information sharing between legitimate providers involved in a patient's care. Specific steps to follow include:

• Conducting comprehensive security audits, penetration testing, and remediation of any vulnerabilities can help secure EHR systems and infrastructure.
• Establishing role-based access controls, robust authentication, and auditing of access can help manage privacy risks.
• Providing training on security protocols and proper data handling can improve workforce compliance.

User Adoption

To fully benefit from EHR capabilities, practices must invest in hardware upgrades and extensive workflow training to integrate systems into clinical processes. Physician resistance or lack of digital literacy can undermine adoption. Optimization requires changes to workflows, communication patterns, and potential new staff roles to capture the benefits of digitization. To help resolve this issue, you can:

• Provide hands-on training, user tutorials, and on-demand support to help improve digital literacy and comfort with EHRs.
• Do workflow redesign initiatives to help optimize EHR integration and avoid disruptions.
• Champion clinician "super-users" to promote adoption and peer learning.
• Foster leadership buy-in and communication to mitigate resistance to change.

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The Future of EHRs in Supporting ACOs

Emerging EHR technologies present new opportunities for ACOs to improve population health management, care coordination, and value-based outcomes. Key areas of innovation include:

EHR Capability	Description	Benefit to ACOs
Predictive Analytics	Sophisticated machine learning algorithms analyze clinical and claims data to predict risk of deterioration, high utilization, or readmissions.	Allows ACOs to better target care management resources.
Clinical Decision Support	AI-enabled tools process patient data in real-time to identify care gaps and provide prompts to optimize treatment.	Helps improve adherence to clinical guidelines.
Comprehensive Patient Profiles	EHRs compile clinical, claims, social, behavioral, and demographic data into complete profiles.	Provides insights into patient risks and needs.
Social Determinants Screening	Structured EHR tools allow standardized screening for socioeconomic barriers.	Helps ACOs identify needs and target interventions.
Patient Engagement	Integrated patient portals enable two-way data exchange and communication.	Promotes patient activation and medication adherence.

By leveraging these emerging EHR capabilities, ACOs can succeed at managing the health of populations, improving outcomes, and meeting quality and cost targets under value-based payment models.

Conclusion

EHR systems provide critical infrastructure for ACO success by enabling better care coordination, population health management, and data analysis to reduce costs. However, ACOs must invest in optimizing EHR use through training and system improvements to maximize value. 

To effectively leverage EHRs for value-based care success, aesthetic medical practices should choose solutions designed specifically for their unique workflow needs. Calysta EMR provides an affordable, tailored platform to help aesthetic practices optimize their EHR technology. 

With industry-specific tools for procedure logging, inventory management, and analytics, Calysta EMR empowers medical spas and aesthetic clinics to improve care coordination, population health management, and practice efficiency. 

Contact us today to learn more about how Calysta EMR can position your practice for success under value-based reimbursement programs.