ICD-10 Helps Accountable Care (ACO)
Wednesday, January 12th, 2011Making ACO a Reality – Organization Structure
Accountable Care Organization, is a physician-led entity – consisting of hospitals, primary care physicians, and specialists – responsible for managing the full continuum of care and accountable for the overall costs and quality of care for a defined population, that is partnered with their health plan. CMS mandates such as ICD-10 are separate from health care reform and were mandated before health care reform became law.
Quality Measures, Incentives
Since CMS 5-Star Ratings are paid to health plans that can only achieve a rating by working with their providers, there is a mutual incentive for all parties to work together for better outcomes.
Enabling Technology
Business Intelligence and dashboards will be key in measuring process improvements for ACOs. ICD-10 implementation costs, while high will ultimately assist companies in getting higher payments from CMS because the granularity of the information and “specificity” will improve the precision of the Quality Measures.
CMS Mandates Force Cooperation
ICD-10 in turn is its own reimbursement system which encourages payor – provider working relationships. Accountable Care organizations will have the most success when they think about coordinated care. Coordinated care means working with trading partners and thinking about the patient experience.
Contact us if you are issuing an RFP or require a quotation for advisory or implementation services in ICD-10, HIPAA 5010, or Accountable Care.
