Accountable Care Organizations and HIM: Steps On the Path. Part 1

In 2010 the Patient Protection and Affordable Care Act provided the initial legislation that introduced Accountable Care Organizations (ACO) through the new Center for Medicare and Medicaid Services (CMS) Shared Savings Program (Section 3022). Dr. Elliott Fisher is originally credited with introducing the concept to the Medicare Payment Advisory Commission (MedPAC) in 2006 as benefits were being realized from the CMS Physician Group Practice Demonstration Project by 10 leading health systems and physician groups from across the country that were documenting savings and validating proof of some of the underpinning concepts that would set the stage for the beginning of the ACO movement. In 2009 Dr. Fisher, Dr. McClellan and colleagues also identified three key principles to guide reform efforts with a focus on accountability, performance measurement and transparency, and payment reform. Today we have new draft federal legislation being commented on by physicians, clinicians, health information management (HIM) professionals, and educators across the country that will help shape the final legislation for the January 1, 2012 launch of the CMS Shared Savings Program. While many private payer focused ACO models and Medicaid ACO models are also being developed and tested across the nation, key to each ACO’s success will be collaboration and teamwork not just within health systems, physician practices and government agencies, but also across multi-disciplinary teams that HIM leaders will and should be engaged in across the country.

Today we are seeing stronger recognition of the need to drive multi-payer coordination (both public and private) on the establishment, definition and activation of ACOs. Having a strong governance structure in place will be key and one that recognizes the importance of meeting Meaningful Use requirements as the industry progresses toward Stage 3 over the next four years, reporting transition to ASC X12Version 5010 by January 2012, and the looming deadline in 2013 for preparing for the industry wide cutover to International Classification of Diseases (ICD) ICD-10 CM and PCS by 2013. ACOs will be regional entities as they focus on providing care to specific population groups and as the ACO models grow in their multi-payer focus the emphasis on care for the entire population in their region will continue to strengthen. For HIM leaders there are a number of challenges to be addressed in supporting information needs in benchmarking, new importance placed on coding intensity, implications in risk models, meeting needs in health information exchange, new reporting to support goals for transparency, and other areas. However, they come with great opportunities to excel and help make these new models of care delivery an even greater success. Improving the health of the population and meeting the “three part aim” identified by CMS as strategic goals for participants in the shared savings program. Those three aims consist of: “(1) better care for individuals; (2) better health for populations; and (3) lower growth in expenditures.” This is the first of a four part series of articles dedicated to key topics of importance to HIM leaders. Next month’s article will focus on the implications of coding in its importance to benchmarking for the CMS shared savings program followed by July’s article on issues regarding health information exchange and involvement of HIM leadership in making it successful for ACOs.

About the Author: Joe Bohn, MBA, is CEO of Clinical Horizons, Inc. ( and co-author of Accountable Care Organizations: A Roadmap for Success. Guidance on First Steps. First Edition. Copies are available on or contact Joe for discounts available on multi-copy purchases. Joe can be reached at

Author: Joe Bohn, MBA, Founder Clinical Horizons


[1] Centers for Medicare and Medicaid Services. Medicare Physician Group Practice Demonstration Project. Fact sheet available at

[2] Fisher ES, McClellan MB, Bertko J, Lieberman SM, Lee JJ, Lewis JL, Skinner JS. Fostering accountable health care: moving

forward in Medicare. Health Aff (Millwood). 2009;28(2):w219-w231; Flareau B, Bohn J, Konschak C. Chapter 1: History and Case for Action.  In: Accountable Care Organizations: A Roadmap for Success. 2011. Virginia Beach, VA: Convurgent Publishing. 2011. p. 13.

[3] CMS-1345-P, Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations. Proposed Rule. I(B)3. Statutory Basis for the Medicare Shared Savings Program. March 31, 2011.