By Mitchell Goldburgh, Business Development, Dell Healthcare & Life Sciences

Even though two Accountable Care Organization (ACO) pilot projects by CIGNA reported lower growth in healthcare costs and improvements in quality of care, a recent study by U.S. News and Fidelity Investments shows that hospital executives are still pessimistic about whether ACOs are a viable long-term healthcare solution.

In this survey of 1,852 hospitals looking at many operating issues facing providers, most of the respondents (two-thirds) showed a high likelihood of joining an ACO over the next three years. However, nearly two-thirds were not so optimistic that, over time, ACOs would significantly improve the quality and efficiency of healthcare. These results beg the question, “If healthcare providers are willing to become part of an ACO, what is missing from the equation to make them successful in the long-run?”

The American College of Radiology (ACR) recently wrote a letter to CMS Administrator, Donald Berwick, MD, outlining why they feel the basic premise of the proposed ACO rule is flawed. In the letter, the ACR delivered more provider skepticism by pointing out that a robust electronic health record (EHR), including diagnostic imaging, is essential for an ACO. “Physicians should incorporate EHRs into their practices, and there should be incentives for developing systems that allow ready transfer of electronic health information, including diagnostic images and reports, between institutions,” ACR CEO, Harvey L. Neiman, MD, FACR writes, adding, “We also request that decision support systems…be tied into the EHRs.”

The good news is that the implementation of EHRs is improving in America. Meaningful Use payment volumes are steadily increasing, to just under $400 million for the year to date, and providers registered (77,549) for the Meaningful Use program are far higher than those getting payments (3,334), according to Government Health IT reports. The bad news is that in transforming healthcare information systems to be more inclusive of data types, along with the expansion of clinical decision support tools, the capacity for clinical repositories and associated storage is also growing. This will lead to increased infrastructure costs for healthcare delivery. Lastly, the complexity of these ‘integrated’ solutions is dramatically changing the need to exchange the information created across organizations.

The conclusion from the adoption of this technology required by physicians and provider organizations is that the essential elements of an HIE (Health Information Exchange) becomes vital to ensure that the information available is complete and useful. An HIE that has the capability of storing clinical registries and encourages the use of ePrescribing is well suited to assist ACOs in gathering data, which is a requirement for reimbursement and associated bonuses based on outcomes. Perhaps, it is the adoption of this infrastructure that will answer the question of whether technology and its associated clinical analytics can deliver on the expectation initially set by pilot programs as reported above.

Today, care decisions based on evidence-based medicine demand that data be shared in a meaningful way across clinical applications. This drives the need for a strong data storage foundation combined with connectivity to support service delivery. Leveraging data standards combined with cost-effective storage platforms spanning into the cloud with validated intelligence for integration from a single vendor makes Dell not only a component provider, but a solutions provider/partner that empowers their customers with tools and technology to meet the dynamic market changes within healthcare.

Unfortunately, certified applications and technologies associated with Meaningful Use and ACOs put providers at risk by developing architectures by accident - new silos of information that multiple, and potentially external, organizations and providers must leverage for sharing. This creates a new demand for data management that exceeds any single application or single entity data management policy. HIEs and their anticipated analytics will drive the need for a more universal solution that is vendor neutral and patient-centric. The rapidly evolving technology and the inability of organizations to scale up with staff, facilities and infrastructure suggest that hosted-based models – or cloud delivery models – pave the way for enabling technology adoption at the lowest cost, risk and shortest time to go-live.

The key to success will be using strategic archiving and cloud services to provide the infrastructure behind the emerging data utilization models that are being driven by Meaningful Use and ACOs. Dell’s vision is to create a cloud-based delivery network for the intelligent management of clinical data through a unified clinical archiving (UCA) framework for unstructured fixed content. Using Dell’s Integrating the Healthcare Enterprise (IHE)-based environment and emerging cloud interface to vendors of Vendor Neutral Archiving (VNA ) products, Dell is able to offer providers access to patient-centric collaboration of clinical data with data management rules that are centered on the collaborating parties and not a specific clinical tool. More importantly, the reduction in duplication of data storage simplifies the operational risk for providers and patients while reducing costs.

Is this data-centric patient management vision widespread or emerging?

A recent analysis of Medicare patients in PCP practices serving 5,000 or more beneficiaries by the Dartmouth Institute of Health Policy and Clinical Practice shows consistent metrics year to year. According to the study, “83 percent of beneficiaries are in the same network in the following year. And most importantly, about 75 percent of the care beneficiaries receive is provided by physicians within either the primary physician-hospital network or the next most frequently used physician-hospital network, usually a referral hospital. These figures suggest that integration and coordination by the physicians within local markets should be feasible and could build upon current practice patterns.”

Thus the combination of patient care patterns along with changes in reimbursement creates an environment that is primed to adopt patient-centric care across organizations. However, unlike prior implementations of managed care, the shift from managed care organizations to provider organizations having to integrate information about patients presents new challenges to all involved. The focus on process automation, consistency of data, and access and analytics of data can only be achieved if the adoption of technology is incented by legislation, such as HITECH Act, and is addressed in a consistent, vendor neutral, and patient-centric way.

Mitchell Goldburgh is responsible for UCA business development, including internationalization and cloud services, at Dell Services. With more than 30 years of experience in medical imaging and informatics, Mr. Goldburgh has successfully led sales and business development efforts for both new and established business lines across multiple imaging sciences and technologies.

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