The health system began rolling out this program earlier this year, and it is being well received among physicians, Dowling says. More than 500 physicians committed to implementing the EHR before November 2010. "I've always looked upon this as a multi-year effort," says Dowling. There is a lot of education to be done, he explains. "When you stand up and say that we want to enhance our IT system and put in EHRs, everyone will say yes. But then when you sit down and explain what all that means it gets more difficult, because it is not just about technology. You have to change work processes." "Everybody knows that we have to manage the coordination of care better than we have done before, so the IT issue is very central to our overall strategy," says Dowling.
Dowling is also positioning the organization to be able to provide all services throughout the continuum. They are expanding their outpatient, long-term care, sub-acute care, and rehab programs. The health system also has established programs for home care, hospice, and palliative care, as well as a transportation network. "Patients don't fit into neat boxes," says Dowling. "We tend to put people in little silos and deal with parts of the individual instead of the totality of the individual. The demands of the future are going to require much more holistic services. So we have to be able to be prepared to do this."
Dowling views ACOs as having the ability to manage care and take responsibility for cost and care of the patient over the continuum. Or to take responsibility for a cohort of patients—like all patients with diabetes or a heart failure. "We'll be paid more based on quality outcomes—not what we do, but based on how well we do it," he says. Fundamentally, ACOs will be able to track patients across the continuum, be able to monitor outcomes, be able to share information, be able to transfer information from one location to another, be able to measure quality, and reduce the annoyance that patients currently suffer by having to repeat things over and over again, Dowling explains.