Accountable care organizations (ACOs) were developed to improve the quality outcomes and the experience of care while at the same time lowering healthcare costs. This mentality requires shifting away from the traditional medical fee-for-service based reimbursement, which is volume based, toward payment models that instead rewards care coordination and quality outcomes.
As such, ACOs are tasked with looking for patient management solutions that can identify patients with gaps in recommended care, empower care managers with automated tools, and engage patients in their care with the overall goal improving quality and health outcomes.
"For an ACO to succeed, it must be able to stratify populations to identify the risk levels of patients, develop care plans to drive improved outcomes, and automate appropriate patient communication so care teams can engage patients in a timely manner," said Gregory Bazylewicz, M.D., chief network development officer for Lahey Health, which launched its Lahey Clinical Performance ACO in 2013 for Medicare beneficiaries in northeastern Massachusetts and southern New Hampshire.
Lahey Health recently integrated a Web-based population health and population engagement platform from Phytel to help the organization achieve those goals. According to the company, Phytel's registry system uses evidence-based chronic and preventive care protocols to identify and notify patients due for service, while tracking compliance and measuring quality and financial results.
Integration was complicated by the fact that Lahey Health needed to integrate the data of multiple applications from different vendors. While the solution will be rolled out initially to physicians employed by Lahey Health, the organization expects to eventually offer it to affiliated physicians who use a wide variety of electronic health record (EHR) and practice management systems.
According to the companies, Phytel will provide Lahey Health with analytics that aggregate data and stratify populations across EHR and other enterprise systems. The system will then compare records with evidence-based care guidelines to identify the top health risks for individual patients.
Care managers reportedly will receive key tools for population health management including EHR-enabled care plans, decision support, user-configurable workflows and personalized care plans. Automated communication features will enable providers to launch patient intervention campaigns —targeting select populations using phone, email and text messaging.
The solution also contains reporting features that will track provider performance against internal and external quality measures as well as report on quality across multiple payers, measures and quality initiatives.
Lahey Health comprises an academic hospital and medical center, community hospitals and nearly 1,000 locally based physicians, behavioral health services, post-acute programs such as home health services, skilled nursing and rehabilitation facilities, and senior care resources.
Edited by
Rory J. Thompson
