Clinical Integration of ACO/IPA's
What is Clinical Integration?
In recent years, the Federal Trade Commission (FTC) has taken a hard look at the operations of the IPA's
to ascertain if they meet the standard of a clinically integrated care delivery model. The FTC considers
this a basic requirement for permitting the continued operation of the IPA. It is no longer enough to prove
merely cost savings through the financial management of the health plan contracts and delivering cost savings
to physicians, health plans and patients. The clinical integration requires the aggregation and analysis of
patient clinical data to help deliver improved care. The IPA, in essence, has to prove that its members act not
as individual physicians, but as a team to deliver coordinated care to the patients.
As a result of this changing environment, many IPA's are transitioning to the ACO (Accountable Care Organization)
model to deliver care. For an ACO also, HIE is central to their operation for purposes of delivering co-ordinated
care and to aggregate and analyze data to meet the regulatory and reporting requirements.
And how does clinical integration work?
While the exact requirements are a work in progress with the FTC, we do know that in order to meet this standard, the
IPA will have to prove a few things:
||That the IPA/ACO is providing the ability for the providers to work as a team, and that in the absence of the IPA's services, such teamwork would not occur.
||That the providers do indeed have access to aggregated and holistic patient records to make the best clinical decisions
||That the IPA/ACO does actively manage, and provide tools to patients, for chronic disease care
||That there is both a positive financial impact and a positive clinical impact of such activities
In order to do any of this, one of the first things that the IPA/ACO will have to gather is data, and the primary
data gathering and aggregation tool is a robust HIE. In fact, this is one of the primary pieces of evidence that
the IPA/ACO is clinically integrated.
How can Sushoo help?
Because Sushoo is a web based, distributed model HIE, the IPA/ACO can get a privately
branded version of the exchange on their website in very little time. In addition, Sushoo is
flexible enough to quickly customize key screens to reduce the learning curve for your providers.
This ensures rapid adoption and acceptance within your constituency. Sushoo is the shortest path
from where you are to achieving clinical integration.
So call us today to see a quick demo on what exactly we can do to help your organization. Call us to find out about
our aggressively low IPA/ACO pricing that can save you tens, or even hundreds of thousands of dollars, each year.