How Health IT Can Support ACO Healthcare Quality Improvement

An EHR-agnostic health IT tool is helping an accountable care organization (ACO) in Nevada enhance healthcare quality across its network of providers.

In fact, just two weeks after the implementation of the Gaps App from health IT vendor IllumiCare, some provider organizations had increased their quality score by over 20 percent, according to Rhonda Hamilton, COO of Silver State ACO.

ACOs set healthcare quality measures that providers must meet, determining what care and coding requirements exist for patient populations. The Gaps App integrates these requirements directly into the EHR workflow for primary care providers (PCPs).

At the point of care, the tool recognizes which patient the provider is viewing in their EHR and checks the status of care and coding requirements for that patient. If care and coding gaps exist, the app nudges the provider in an unobtrusive way.

The result is the ability for providers to easily track and close these care gaps during the patient visit.

“The tool makes it so much easier for the providers to identify and address those care gaps,” Hamilton told EHRIntelligence in an interview. “Having the ability to close care gaps and monitor those at the point of care is going to improve patient outcomes. We've seen improvement in quality scores already in the short amount of time we've been using it.”

“For us, closing those gaps is going to make sure that patients are following up on their care and that all preventative measures are being done appropriately, which is a challenge in this post-pandemic world,” she continued. “A lot of people can be hesitant to go out and do their preventative care, so making sure that the providers are following up on that is really important for us.”

Hamilton noted that the app enhances interoperability of patient health data across the ACO for care coordination. For instance, PCPs are able to see if a specialist provider within the ACO closed a care gap.

Currently, the health IT vendor can report about a 50 percent open rate—in other words, providers open the app once for every two nudges they get.

And from there, providers close care gaps within an average of two weeks of a provider seeing a gap, Hamilton said.

Providers across the ACO have taken to the health IT implementation well, Hamilton added.

Just a week into the app’s rollout at Silver State, providers expressed excitement about the new technology, noting how beneficial it is to know what the patients need while the patient is in the room, Hamilton said.

“It's gotten great feedback and we’re very excited,” she said. “It is so easy to use, which is fantastic. The easier it is to use the more clinicians are going to be willing to use it.”

Hamilton said that the health IT’s EHR-agnostic-nature was a key selling point for Silver State, as the ACO has over 50 provider organizations that operate on about 30 different EHR systems.

“With the cluster of different EMR systems we have, we were really looking for something that would work with any EMR and ideally not involve too much interaction with the EMR company, because that can be a very lengthy and expensive process,” Hamilton explained.

Silver State also wanted to make sure implementation would happen within a reasonable timeframe. And since Hamilton has previously found some EHR vendors can be a little slow to do anything out of the box, it was important the ACO found an EHR-agnostic tool that it could get up and running in a few weeks.

Hamilton said that the executive team for the ACO, providers on the ACO’s governing board, and a quality assurance subcommittee were involved in the purchasing decision.

“One of the things that we liked most about IllumiCare was they share our vision and they were willing to tailor the app to our specific needs,” she noted. “They've been a great partner.”

Hamilton said that Silver State is looking forward to rolling out the next sections of the app which are set to provide clinicians with HCC coding gaps, as well as emergency department and inpatient data.

“HCC coding is really important for our practices,” Hamilton said. “It's the risk stratification that Medicare is going to use as well.”

Hamilton noted that as an ACO, appropriate risk adjustment is vital.

However, Medicare wipes out HCC codes every year, which is essentially like hitting the reset button. According to Hamilton, this practice neglects to acknowledge that a diagnosis from the year previous could still deem a patient high-risk.

“Unless the providers are remembering to code every single thing again every year, those things are getting dropped off and they're not taken under consideration when Medicare is looking at the appropriate level of spend for the patient,” she explained.

The next section of the app will provide clinicians with HCC codes for last year’s diagnoses that are not coded yet for this year. With this information, providers can see if those codes are still appropriate and code them on the patient's chart if need be.

Additionally, Silver State is looking to integrate emergency department and inpatient hospital stay data into the application in order to enhance care coordination.

“A lot of times, patients won't remember necessarily to tell their provider if they were in the ER,” Hamilton said. “A lot of readmissions can be avoided if the provider knows the patient was in there, as they can help the patient reconcile their meds and make sure their post-acute orders were followed through.”