I argue that Accountable Care Organizations (ACOs) do not represent a health care delivery revolution, but an evolution. Based on my experience in LTC and what I’ve been reading on the Internet, ACOs appear to be an evolutionary variant of the species known as HMOs. Regardless, ACOs represent a significant change to health care delivery. The ACO model will have a sweeping impact on how health care is planned for, delivered, documented, reported, and paid for. It follows that for an ACO to work, information technology serves as the glue that holds it together; those providers who have successfully worked with HMOs can attest to the critical role IT plays. Participation as ACO members will require providers to carefully evaluate what such participation will have on their respective IT systems.

Let’s explore this in more detail.

An ACO is a group of providers and suppliers of services that cooperatively deliver seamless, high-quality care to Medicare beneficiaries while reducing costs. Therefore, ACO providers must coordinate, deliver, document, monitor, and report patient care not only in terms of the quality of the care delivered, but the costs related to that care. The key word here is “interoperability.” This means the ability of health information systems to work together within and across organizational boundaries in order to advance the cost-effective delivery of healthcare. Interoperability involves seamlessly integrating data and information within each organization and among all providers who participate in an ACO.

More expansively, “interoperability” includes:
• Moving data among all providers
• A consistent data presentation
• A uniform user interface or controls
• Data security and integrity
• Uniform protection of patient confidentiality
• Consistent system service quality

In other words, each provider must at least have a fully-integrated clinical and financial system in place. This system must reliably, securely, and with interoperability communicate with other ACO members’ systems.

So, what’s the impact on a provider’s IT infrastructure? In general, the IT infrastructure will need to include:

So, if ACO’s are in your organization’s future, will you be ready?
• Do you know where IT is today and what you will need?
• How much will it cost to get IT up and running quickly, securely, and affordably? With outsourcing* - sooner than you think and with little to no capital.
• How much will it cost to maintain it? It’s less expensive than you may think.

If ACOs are not in your future, is the IT infrastructure checklist relevant? We’ve found that if you think it is, you’re ahead of the curve. However, if you think not; we urge you to think again.

*Cloud-based managed hosting infrastructure, services, and solutions have helped LTC providers leverage any and all such opportunities, such as ACOs offer, quickly and affordably.

Questions:
Are ACO’s in your future?
What impact do you think ACOs will have on IT?

It’s that time of year again.
In 2011, the desolation and loss of life in the wake of the massive tornados in Joplin, MO, in Tuscaloosa, AL, and other states have captured the attention of LTC providers across the country with the realization that disasters can strike anywhere, at anytime. They recognize the need for a real-world, workable, and well-rehearsed disaster preparedness and recovery plan that at least minimizes, if not prevents, injury and loss of life during and after a disaster.

Post-disaster recovery, however, must also encompass access to resident information, because in the world of EMR, electronic data can be lost if the servers or other storage devices are damaged by fire, flooding, or building collapse. Fortunately, there are steps which you can implement now to protect that vital information before a disaster strikes.

Backup procedures (a good start) - A basic IT disaster preparedness plan must include a regularly-scheduled daily back-up of data with off-site storage and I don’t mean in an employee's home. Tip: One important thing to remember about backups: they should be regularly tested. Nothing is more frustrating than to need a backup and find that the data is corrupt or non-existent.

Fault tolerance - The next step up in disaster recovery is to build fault tolerance into all of your critical systems. This means installing Redundant Array of Independent (or Inexpensive) Disks (RAID) drives (disk drives which are redundant copies of each other), clustered systems, and other types of local recovery procedures.

What happens if - Once you have a good backup and archiving procedure with critical fault-tolerant systems in place, the next step is to put together procedures for remote disaster recovery.

Option: Co-location

You might, for example, make arrangements with another company to share equipment and space if either is struck by disaster. Such an arrangement also requires agreements with critical computer vendors to quickly ship new systems in the event of an emergency. Although recovery would be slow, this kind of planning is a good first step.

Option: A Split Site

Some companies are large enough that the IT department could be staffed at more than one location. In the event of a disaster to one site, operations would simply shift to the other.

Option: A Cold Site

This is a site (often managed by a third party and shared among multiple clients) which is stocked with equipment and ready to go. The remote servers are generally not “live,” and time is required to activate the off-site system should the need arise. This is a popular disaster recovery method, because it tends to be less expensive than other options and gives a company the ability to be up and running with a brief delay.

Option: A Warm Site

If a company has the resources, then a warm site is a viable alternative. This is a site which is pre-positioned with equipment, software, and other necessities ready to go in the event of an emergency. The equipment is idle, often turned off, but can be quickly restored and brought online. Data is available quickly and can be restored without much difficulty. However, a high level of competence and forward thinking is required to plan, build, and maintain it.

Option: A Hot Site

In this scenario, a duplicate computer center is available in a remote location from as little as a few miles to hundreds of miles away from the primary computer facility with communications lines set up and actively copying data at all times. At a minimum, the site has a duplicate of every critical server up and running with data that is up-to-date.

Option: The Cloud

By its very nature, the cloud is designed to handle business continuity; high availability; and disaster recovery. So that in the event of a disaster, management and staff can access business-critical applications and data anytime from anywhere. Cloud Services Providers (CSPs), like PCT, provide pooled resources, flexibility, scalability, security, and reliability to businesses of all sizes so that businesses can store their data, applications, systems, and services.

Don’t wait! Act!

Regardless of the option you choose, having a viable systems and data disaster recovery system is critical.

How the Cloud can help you meet today’s opportunities more rapidly

OK. So what is “the cloud?” In general, cloud computing refers to anything that involves delivering hosted services over the Internet. Because the cloud symbol has been used for a long time in flowcharts and diagrams to represent the Internet, the use of the term, “cloud computing,” is logical. So what’s the recent buzz about cloud computing - especially for health care providers?

To the point, virtualization, distributed computing, and improved access to high-speed Internet have accelerated interest in cloud computing. Indeed, but what’s the benefit?

Cloud computing technologies enable companies to access and pay for only the needed capacity and increase capacity as soon as required. This means that cloud computing is efficient, flexible, and scalable. Because cloud computing usually is a subscription-based model that extends a company’s IT capacity, it’s very affordable. Companies who leverage the cloud can increase their IT infrastructure and computing capacity without having to invest in new infrastructure, e.g. the hardware; hiring, training, and retaining new personnel; administrative overhead; and licensing issues.

How the Cloud can help you meet today’s challenges and opportunities

The path of cloud computing is probably the most direct route for any company to reach its IT goals to empower growth and to stay competitive. It avoids the roadblocks and difficult-to-surmount obstacles of:

• Capital investment, including purchasing, maintaining, upgrading, and replacing hardware, such as servers,
• Additional IT staffing,
• Burdensome administrative overhead, and
• Potential risks to on-premise resources are exposed by offering redundancy, high availability, and disaster recovery provided at a significantly lower cost. 

Cloud computing can be deployed rapidly and frees up a company’s internal resources to focus on strategic issues while leaving the day-to-day IT operations to service providers who have superior technology, experience, support, expertise, best practices (including security with UTM and VDOM technologies), interoperability, and economies of scale.

Example: Health care, ACOs, and the Cloud

Let’s look at health care and ACOs, for example. ACOs (Accountable Care Organizations) can represent an opportunity, a threat, or something to be ignored. If you are a health care provider, I will assume you understand ACOs and what they mean to your organization. The real question is, if you view ACOs as an opportunity, are you ready to work together with other providers to coordinate patient care and share in the savings and risks of doing so? For ACOs to succeed, they need IT across the entire continuum of their membership. At a minimum, your organization must be ready to:

• Identify the patients/residents you care for
• Be able to measure, analyze, and assign costs to the care you deliver
• Input, store, retrieve, and compile the data into useful information for all members of the ACO and CMS
• Produce periodic aggregated reports
• Conduct patient/resident satisfaction surveys
• Have EHR in place
• Alter the way you deliver the care to improve outcomes while reducing costs
• Be able to monitor all of the above in real time.

This takes information automation to a new level of IT capacity and functionality which many providers do not posses and cannot see how to afford let alone implement quickly.

Conclusion

The “cloud” can help businesses acquire the IT infrastructure and tools in a relatively short period of time. As an ACO member, health care providers can focus their internal resources on identifying ways to reduce costs and improve quality as the cloud works behind the scenes to retrieve, protect, deliver, and report the metrics needed.

My questions for you:

Is your organization entertaining the idea of participating as a member of an ACO?

What IT challenges is your organization facing and how are you planning to meet those challenges?

Introduction

An operator of over 35 facilities in four states has been using its digital dashboard to effectively manage census, labor, collections, and MDS information. The company’s BI/digital dashboard project manager cited three reasons that it has become an increasingly successful day-to-day management tool.

Reason #1 - Who needs to see what?

Through planning and coordination with its dashboard developer, in this case – PCT’s primeVIEW, this provider has carefully identified who needs to see what. Senior management, together with key corporate department heads, regional VPs, and the IT team, compared the information displayed by the dashboard with roles and responsibilities throughout the organization. From senior management to corporate departments to regional staff to facility administration, the real-time reports were aligned with accountability and action. For example, while senior management may want a global view of Key Performance Indicators (KPIs), such as census, labor, collections, MDS-driven information, critical to them, they did not necessarily need the granularity that the drill-down function afforded to regional staff or corporate department heads. Accordingly, management is able to review reports from primeVIEW which give them the ability to globally assess and address trends, practices, and policies

Historically, view of the dashboard at the facility level had been limited to the administrators and executive directors. However, recently, the company granted permission to department heads to view their specific department KPIs, particularly labor. This gives them the ability to scrutinize such issues as overtime or who may be “milking the clock.” For example, are some employees adding 15 minutes to their punch time in non-productive activities (or malingering)? Because the system refreshes the clocked-in and clock-out times by employee, department heads can identify such issues as they happen. 

Reason #2 – Personal Training

Training is critical in two major areas:

• How to access and use the tool and
• How to apply critical thinking to day-to-day tactical and long-term strategic problem solving

Because the system is intuitive and easy to use, most follow-up training takes place on a case-by-case basis after the initial orientation and training. Their BI project manager views the dashboard throughout the day and can tell over time who may need additional support and training tailored to the individual’s needs.

Critical thinking applied to problem solving helps managers effectively resolve problems or seize opportunities. Regional staff works closely with their facility counterparts to interpret dashboard information and create workable action plans.

Reason #3 - Refer to the dashboard regularly; make it a habit

Because the dashboard puts actionable KPIs at the fingertips of those who need it without having to go through someone else, managers can respond quickly. This requires the discipline to refer to the dashboard regularly. Those who do, benefit.

What have been the benefits?

The Project Manager reports that the corporate and regional teams can readily identify the problem facilities and can proactively respond before the issues get out of hand or opportunities are missed. This has resulted in a marked reduction in unnecessary costs and the discovery of opportunities to improve resident/patient services.