Rigorous performance measurement and evaluation - best accomplished with an electronic health record system - will be critical to the success of accountable care organizations, according to industry experts.
In an article sponsored by the Commonwealth Fund and appearing in the Journal of the American Medical Association on Oct. 20, Elliot Fisher and Stephen Shortell say that integral part of implementing ACOs, will be measuring processes and outcomes across the care continuum to support improvement and accountability and reduce the administrative burden associated with performance measurement.
In crafting the Affordable Care Act, Congress assigned an important role to ACOs in helping physicians, hospitals and other providers work together more effectively to improve quality of care and slow health spending growth, according to Fisher and Shortell.
Fisher, who directs the Dartmouth Institute for Health Policy and Clinical Practice, and Shortell, dean of the School of Public Health at the University of California at Berkeley, say ACOs could use different measurement approaches depending on the capabilities of their health information technology systems.
ACOs that lack electronic health records could at first rely on measures gleaned from claims data - like cancer screening - then adopt measures of health outcomes and patient-reported care experiences. The most advanced ACOs - those that currently have EHRs across all sites of care - could measure informed patient choice and outcomes for an array of conditions, the authors said.
The authors also argue that performance measures in healthcare are too narrowly focused on individual clinicians, rather than the systems of care in which they operate.
And, they call for a common framework for evaluating the range of delivery and payment reform initiatives in the Affordable Care Act to help determine which ACO characteristics are critical to their success.
