Does ACO Spell Audiology?

Tom J. Northey, MSM

Tom J. Northey is this week’s guest contributor.  In July, Hearing Economics did a multi-part series going back in time to 2000, when Mr. Northey wrote a seminal article forecasting our profession’s future choices and coining that popular phrase “Audiology Economics.”

Lucky for Hearing Economics, the series caught Mr. Northey’s attention.  Though he left the field of Audiology years ago, he graciously agreed to think more on Audiology in 2014.  Here’s the first half of his current forecast of what’s ahead for Audiologists in the changing healthcare market place.  There are a lot of new terms, concepts, and “to-do’s” ahead of us.  We’re grateful to Mr. Northey for taking the time to explain and point the way.

As the whirlwind of healthcare disruption continues to reshape and reform how healthcare is delivered, ancillary providers such as audiologists may be wondering, “where do we fit in?” While the question may seem premature to some audiologists, the forward-thinking owners and business planners are prudent in pondering the future-today. But before the “How” is analyzed, we need to begin with the “What.”

What is Happening?

Healthcare is moving from volume (think fee-for-service, getting paid for sick people) to value (getting paid for keeping people healthier).  In this transition, the payment model is being reversed.  In this reversal, entrenched, long-term, systemic payment and treatment processes must be uprooted and replaced by entirely different reimbursement and treatment models.

Fig 1. ACO access by state.

ACOs: Right Time, Right Place, Right Patient

Enter the accountable care organization or ACO model.  An ACO is a collaborative provider network or ecosystem that seeks to coordinate care around a defined population of patients for the purpose of driving down costs while at the same time improving the quality of the care delivered.  The ultimate end is to increase the health of the patient through a plethora of preventive interventions.  The glaring example is the deployment of care management (or care coordination) activities for chronic condition patients such as those with diabetes, chronic heart failure/hypertension, asthmatics, obese patients, etc.

The average Medicare patient over the age of 65 is usually “managing” three co-morbidities.  An example of a care coordination activity would be to assign a chronic patient to a specific care team (comprised of nurses, health coaches, physicians, etc.) to track that patient’s diet, exercise regimen, medication adherence, appointment adherence, bloodwork/lab results and overall program compliance to increase the overall health of that patient while at the same time lowering the risk for a hospital admission (ER visit).

In the ACO world the out-patient provider (think ambulatory primary care physician) becomes the gatekeeper/cost control linchpin of the ACO ecosystem. This ecosystem is only functional if patient data can be seamlessly “exchanged or transmitted” around the ecosystem “at the right time, at the right place, for the right patient.”

How This Affects Audiology

We have all heard of the Kaiser model.  The secret to that model’s success and all the successful initiatives it produces centers on its providers (hospitals, ambulatory care, specialists, ancillary providers) being on the same electronic medical record system or emr.

In other models disparate systems are “bridged” together via various health information exchange  (HIE) tools to allow for patient data to flow from one system to another for patient care.  EMRs eligible to participate in this exchange, and thus ACO models, must meet certain certification standards (enter the term Meaningful Use).

That successful emr models exist and are already functional raises two key considerations for Audiology.

First Consideration:  Audiology today has no such system.  As a profession it is not certified and thereby interoperable with certified healthcare emrs.

Second Consideration:  What really needs to resonate with Audiology is what will happen to audiologists if they DON’T get a system and can’t participate in these ACO models.

Tune in next week for the second half of this long post, where Mr. Northey tells us how to get started on a certified system and tell us why not getting a system is a really bad idea.

Tom J. Northey, MSM, founded the first Audiology IPA in Colorado (ACI Network) and negotiated its sale to Starkey in early 2008.  Since then, he has held management positions in Health Information Exchange (HIE) and Accountable Care Organizations (ACOs).  Currently, he is Executive Director of the California Rural eHealth Information Network (CAReHIN.org).

photos and figures courtesy of Detroit Free Press,  Oliver Wyman