white paper - building your aco and healthcare it’s role

Building Your ACO and Healthcare IT’s Role

NextGen Healthcare Collaborative Care Solutions Update

a QSI company

TM

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Healthcare at the Speed of LightWhere do you fit in the American healthcare ecosystem? You need to know. Where does your practice stand

relative to one of the most complex, interconnected, and constantly evolving business models in the history of

healthcare? Being clear on where you are in the stakeholder spectrum, and what you need to do to succeed, is

essential to meeting today’s healthcare marketplace demands. The tools needed to capture, organize, and share

healthcare data are truly evolving at the speed of light.1

The HIT Revolution — It’s Unstoppable

People and organizations offering the best HIT insights, knowledge, skills, and technologies to successfully

manage the healthcare information revolution, constantly assess how to provide value to the market. They are

highly sought-after because they move with the market. They are always relevant and timely.

These industry pundits create dialogs and relationships with stakeholders that reflect market realities and

stakeholder objectives. These high performers turn roadblocks into opportunities. They will always be in high

demand, as will HIT solutions that advance the quality and efficiency of American healthcare.

Stephen Lieber, president and CEO, Healthcare Information and Management Systems Society (HIMSS), said

last summer at a vendor leadership exchange in Chicago, “The change in healthcare to be more like the rest of

American business… is underway and will not be stopped.”2

The country’s health IT leader, Farzad Mostashari, heads the Office of the National Coordinator for Health IT

(ONC). At the first 2012 meeting of the Health IT Policy Committee he said, “In 2012, Meaningful Use will soar.”

“We’re going to do everything we can to ensure that every provider can be successful at Meaningful Use. Vendors and providers are going to be asked to step up to the challenge – and it is a challenge. But, it’s a

challenge well worth meeting.”3

Farzad Mostashari, Office of the National Coordinator

Building Your ACO and Healthcare IT’s Role |

What We Know Today — How We Prepare for Tomorrow

Healthcare stakeholders of every size and description in 2012 are gearing up for a faster pace of HIT adoption,

implementation, and increased influence in every part of the clinical, financial, and administrative workflow. We

know the hottest buzzwords and we understand their true implications:

• Meaningful Use (MU)

• Patient Centered Medical Home (PCMH)

• Accountable Care Organization (ACO)

Today, public and private organizations have a loose understanding about these quality care mega models. In

fact, the federal government, many non-governmental organizations (NGOs), and private sector professional

societies have created their own distinct definitions. NextGen Healthcare is and has been a leading innovator

supporting emerging healthcare reform models and patient engagement as far back as 2003. We understand

health reform, the implications and trends, and are developing the best solutions to ensure short- and long-

term success for the healthcare community in overcoming challenges faced by physician practices, hospitals,

HIEs, the government, Integrated Delivery Networks (IDNs), and other providers across the country.

ACO

ACO ORGANIZATION

Infrastructure and Legal Entity

Manage, Monitor and TrackAcross the ACO Network

Governance and Administration

PCMH

LargePrimary Care

Practice

LargeMulti-

specialty

IntegratedDeliverySystem

PracticeProvider

IPAand/orMSO

ACO PARTICIPANT

Patient Centered Care Delivery

Population Management

Patient Satisfaction

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MU Momentum

Meaningful Use is on the fast track of adoption and acceptance. The federal government has given providers

more time to ramp up electronic health record (EHR) implementations – the initial focus of the Centers for

Medicare and Medicaid (CMS) EHR Incentive Program. The Comment Period available through the federal

government’s regulations.gov website is open for feedback on the MU Stage 2 Proposed Rules until May 7, 2012.

Even so, while hospitals maintain their impressive EHR adoption momentum in 2012 and beyond, small physician

practices will begin moving beyond “the unstoppable” as earlier adopters receive and publicize their MU

incentive checks.

Regardless of current national adoption rates, EHRs and MU already are entering a new phase prompted by the

legal implications of Health Insurance Portability and Accountability Act (HIPAA.) Security breaches, EHR default

templates, and cloned notes (causing improper billing) are forcing CMS to begin auditing recipients of incentive

payments in order to validate their attestations.4

PCMHs, ACPs, and ACOs

Quality and accountable care delivery models are gaining momentum. Already, many hospitals, physician

organizations, and payers across the country are scrambling to form ACOs. For example, the first accountable

care program in New York City involving a Physician Organization and a Health Plan was announced in January

2012.5 In the announcement, Cigna® said that collaborative, accountable care is the carrier’s approach to

accomplishing the same population health goals as ACOs.

In late 2011, CMS announced the final list of 32 healthcare organizations from across the nation selected to

participate in the new Pioneer ACO initiative.6 Its objective is to encourage primary care doctors, specialists,

hospitals, and other caregivers to provide better, more coordinated care for Medicare patients; it’s projected to

save up to $1.1 billion over five years. NextGen Healthcare will be working with several of these leading Pioneer

ACO organizations to assist them with measuring and reporting the 33 new CMS ACO criteria.

The Role of PCMHs in ACOs

Technology, staff, and workflow transformation are necessary to achieve Patient Centered Medical Home

recognition. This transformation allows health care providers to deliver higher quality coordinated care by

streamlining and rationalizing the patient experience. With organized patient visits that are documented

using HIT tools, providers can more seamlessly and accurately measure outcomes. These elements are an

essential foundation for Accountable Care. PCMH measures are nested within the measures published for

the Pioneer ACO program, which is reflected in the National Committee for Quality Assurance (NCQA)

ACO Accreditation Program.


At a basic level, the concepts of PCMH and ACO models are very different; however, they both share similar

quality-based elements. The PCMH is a model of care delivery, a recognition program for primary care and

relevant specialists, and is also an incentive program for providers who meet a level of NCQA recognition

(offered by both public and private payers across the country). Continuous quality improvement in care and

cost savings are the primary goals. Both healthcare reform models are patient-centered and rely on coordinated

care; however, PCMH can be a stepping stone to becoming an ACO. The PCMH model is based on primary care

delivering quality health care in close coordination and partnership with all community care partners. Although

each PCMH and ACO varies in scope, the two models work hand-in-hand, with a PCMH model acting as a

requisite to becoming an ACO.

That said, ACOs include and assume that PCMH care delivery models are in place. They further incorporate the

concept of multi-provider data liquidity and an enterprise governance structure covering the diverse types of

providers. In addition, ACOs utilize population management strategies, as well as specific quality measures and

business intelligence tools.

NCQA ACO Accreditation Program criteria require that an ACO:7

• Ensures access to and availability of care

• Has a solid foundation of patient-centered primary care

• Has the necessary care management and coordination capabilities

• Monitors practice patterns and uses performance data to improve quality

• Utilizes decision support to help patients and providers identify the best care

According to a Health Policy Brief published by the Robert Wood Johnson Foundation, an ACO is “an

organization, virtual or real, that agrees to take on the responsibility for providing care for a particular population

while achieving specified quality objectives and constraining costs.” ACOs are accountable for both quality and

cost of care for a defined population. The promise of cost containment is a major driver for payers considering

ACO partnerships with physician groups.

Care Coordination and ACOs

To become an ACO, care coordination in relation to quality is important and necessary. Organizations that

do meet these standards will be financially rewarded in order to encourage further improvements in care

coordination. Providers will be paid on a fee-for-performance basis with incentives based on certain objectives.

The goal of these efforts is to reach a fully-coordinated care delivery system.

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NextGen Healthcare contributes to an ACO’s success through the exchange of clinical and financial data across

the continuum of care, supporting the ACO’s responsibility to measure, monitor, and manage its participating

population. The common driver is that both sides are committed to continuous healthcare improvement and cost

reduction. The goals of the “Triple Aim8” health reform programs are to:

• Improve patients’ experience of care

• Improve population health

• Reduce overall healthcare costs

EHRs and MU – The Root of the Pay for Performance (P4P) Model

There is a strong link between MU and the NCQA ACO Accreditation criteria, which supports engaging patients

in the wellness and care delivery process. Implementing an EHR system is central to meeting and attesting to the

quality measurement criteria. Eligible professionals and practices can earn Stage 1 MU reimbursements from

CMS ranging from $44,000 to $63,750 by demonstrating MU of a certified EHR for:

• ePrescribing

• Sharing clinical data with other certified EHR systems

• Reporting on specified clinical quality measures

EHRs drive the capture and reporting of MU data beyond Stage 1 to include the following PCMH/ACO MU attestation requirements:

• Drug formulary, drug use, drug allergy checks

• Electronic prescribing

• Maintaining up-to-date problem list of current and active diagnoses and medications

• Recording demographics on preferred language as well as gender, race, ethnicity, and date of birth

• Recording and charting changes in vital signs

• Recording smoking status

• Reporting ambulatory quality measures

NextGen Healthcare clients are earning CMS MU incentive revenue, and are establishing PCMH and ACO

organizations, using the following NextGen Healthcare core products: Certified NextGen® Ambulatory EHR,

Certified NextGen® Inpatient Solutions; NextGen® Patient Portal, NextGen® Health Quality Measures, NextGen™

Health Information Exchange, and a built-in ePrescribing module.


How NextGen Healthcare Supports PCMH, NCQA Recognition Levels 1−6

NextGen Healthcare is constantly re-evaluating and upgrading processes to provide value and results to clients.

Hospitals, practices, and physicians establish a NextGen Healthcare partnership based on our track record and

the value clients get from our knowledge and technologies. We ensure our clients are prepared and successful in

supporting new aspects of payment reform and quality measurement. Helping our clients meet NCQA Standards

to establish PCMH and/or ACO status is a major focus for NextGen Healthcare in 2012 and beyond.

Current NCQA PCMH: 6 Standards, 27 Elements, 149 Factors

step1 step535–59

points and all six must-pass

elements

60–84 points and all six must-pass

elements

85–100 points and all six must-pass

elements

level1 level2 level3THE POINT ALLOCATION FOR THE THREE LEVELS OF PCMH

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Summary of Current NCQA PCMH Standards9

There are a total of six PCMH standards that participants achieve and combine to reach one overall score. Each

standard consists of several specific elements. Standards evaluate a practice’s ability to function as a patient-

centered medical home (PCMH). The following table provides a content requirement summary for each of the six

PCMH standards along with NextGen® solutions available to achieve each standard.

PCMH STANDARD PCMH CONTENT ELEMENTS OF ACO

PCMH 1:

Enhance Access/Continuity

PCMH 2:

Identify/Manage Patient Populations

PCMH 3:

Plan/Manage Care

Patients have access to culturally and linguistically appropriate routine/urgent care and clinical advice during and after office hours

The practice provides electronic access

Patients may select a clinician

The focus is on team-based care with trained staff

The practice collects demographic and clinical data for population management

The practice assesses and documents patient risk factors

The practice identifies patients for proactive reminders

The practice identifies patients with specific conditions, including high-risk or complex care needs and conditions related to health behaviors, mental health or substance abuse problems

Care management emphasizes:

Pre-visit planning

Assessing patient progress toward treatment goals

Addressing patient barriers to treatment goals

The practice reconciles patient medications at visits and post-hospitalization

The practice uses e-prescribing

Patient/caregiver experience

Preventive health

At-risk Populations (diabetes, hypertension, ischemic vascular disease, heart failure, coronaryartery disease)


At-risk Populations (diabetes, hypertension, ischemic vascular disease, heart failure, coronaryartery disease)

NEXTGEN® SOLUTION

NextGen® Practice Solutions

NextGen Ambulatory EHR

NextGen Patient Portal

NextGen® Dashboard

NextGenTM Consulting Services

NextGen® Mobil 2.2


NextGen Health Quality Measures

NextGen Dashboard

NextGen HealthInformation Exchange



NextGen Inpatient Solutions

Lab & Pharmacy integrated or third party


The Power of Data Integration

Data integration from disparate stakeholder sources throughout the healthcare ecosystem is the “final state”

objective of the HIT revolution. Multiple source data reciprocity — fully reliable, accurate, transparent, and secure

data integration to and from every healthcare stakeholder – isn’t a reality today. However, it is the HIT foundation

– information as a service – that supports collaborative care coordination within a fully-functioning community.

As the shared risk payment model between physicians and payers matures, healthcare providers will be required

to quickly and easily aggregate current and past information about a patient’s health – from the patient’s entire

continuum of care, in order to:

1. Support decisions at the point of care

2. Empower the patient to engage with their care team

3. Assist patients in executing the latest care plan created for them by their physician

4. Coordinate care across the ecosystem

PCMH STANDARD PCMH CONTENT NEXTGEN® SOLUTION

PCMH 4:

Provide Self-Care Support/Community Resources

PCMH 5:

Track/Coordinate Care

PCMH 6:

Measure/Improve Performance

The practice assesses patient/family self-management abilities

The practice works with patient/family to develop a self-care plan and provides tools and resources, including community resources

Practice clinicians counsel patients on healthy behaviors

The practice assesses and provides or arranges for mental health/substance abuse treatment

The practice tracks, follows up on and coordinates tests, referrals and care at other facilities (e.g., hospitals)

The practice manages care transitions

The practice uses performance and patient experience data to continuously improve

The practice tracks utilization measures such as rates of hospitalizations and ER visits

The practice identifies vulnerable patient populations

The practice demonstrates improved performance

NextGen Consulting Services

Physician Resources Services

Patient Portal Community



Disease Management


NextGen Dashboard

NextGen Consulting Services

NextGen Practice Solutions



NextGen Patient Portal

NextGen® EHR Connect



Medication Management

HQM

ELEMENTS OF ACO


Patient/caregiver experienceCare coordination/patient safety

At-risk Populations (diabetes, hypertension, ischemic vascular disease, heart failure, coronary artery disease)

The Must Have — Interoperability

True clinical integration of patient care around PCMH and ACO models requires HIT interoperability with other

organizations. To successfully connect disparate technology systems — while reaping the associated benefits of

controlled data flow, decreased costs, and reduced errors — providers need a powerful and proven HIE solution.

A robust HIE/Data aggregation strategy is needed to support interoperability and a clinically integrated structure.

NextGen Health Information Exchange – Private

The goal of HIE technology is to facilitate access to, and retrieval of, clinical data for enhanced patient care. With an HIE, providers are able to mobilize healthcare information electronically across organizations within a community, a region, or across the country. HIE provides the capability to electronically move clinical information among disparate healthcare information systems while maintaining the meaning and security of the information being exchanged.

NextGen Healthcare Enterprise

Non-AffiliatedSystem

Pharmacy System

Ambulatory EHR

Hospital

Laboratory System

Patient Portal


Evolution of Participation — Shared Savings Model Criteria10

The Shared Savings Model (SSM) – also referred to as the “Shared Risk Payment Model” – seeks to reduce

fragmentation in care delivery, improve overall patient population health, and lower healthcare costs. Providers

will need to work cooperatively across the healthcare continuum to overcome siloed care delivery, treat patients

effectively, and help them stay healthy.

3-5 Year Process

PM System

PR

AC

TIC

E R

ED

ESI

GN

FINANCIAL MODELEHR and Registry

CLINICAL QUALITYPROGRAM

Patient Portaland HIE

ESTABLISHMEDICAL HOME Automated

PatientOutreach and

Physician MobileSolution

CONTRACT P4PWITH PAYERS Enterprise

PerformanceManagement

ENGAGE INACO OR SHAREDSAVINGS MODEL

ststepep11 ststepep22 ststepep33 ststeepp44 ststeepp55ADOPTION CURVE

Reports vary widely on how long it will take providers to establish ACO or SSM practices. Part of the value that NextGen Healthcare and the NextGen Healthcare network can provide to clients and prospects is to educate them about the ACO/SSM adoption process. NextGen Healthcare provides guidance and recommendations about the specific challenges, opportunities, and tools required for success at each step of the build process.

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NextGen Healthcare Core Products Support the Functional Pillars of an ACONextGen Healthcare provides the technology systems to help healthcare providers build a successful PCMH

and ACO. Clients can use our systems to create the functional pillars of an ACO including development of an

HIE; establishing medical home practices; quality patient outreach; reporting and compliance; financials and

analytics; claims; patient management; administration; clinical data; registries; and continuous documentation

improvement. Our clients’ ability to successfully implement these initiatives is supported by NextGen Healthcare’s

Solutions Foundation which includes our core products.

The NextGen Healthcare Solutions Foundation

HIE andPortal

MedicalHome

Practices

PatientOutreach and

Mobile

QualityReporting

and BI

Financialsand

AnalyticsClaims/Clinical

Functional Pillars of an Accountable Care Organization

NextGen Healthcare Foundation

Accountable Care Organization

Meaningful Use Stages


NextGen Practice Management

NextGen Inpatient Solutions

NextGen

Health InformationExchange

NextGen

PatientPortal

NextGenPopulation

Management

BI/NextGen

Dashboard

NextGenHealthQuality

Measures

NextGenConsulting

Services

NextGen Healthcare provides the tools and systems needed to help providers evolve through MU on the way to an ACO delivery model with minimal disruption to their practices. The NextGen Healthcare Solutions Foundation provides the technology, systems, infrastructure, and training required for the transition regardless of where practices and physicians currently find themselves in the process.


NextGen Healthcare Solution Evolution – Interoperable and Scalable

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There are several products and capabilities necessary to support Meaningful Use, 2012 NCQA PCMH, and Accountable Care constructs. Each NextGen Healthcare product supports interoperability and is scalable for the single practitioner to a multi-hospital integrated delivery network. The NextGen Healthcare vision includes our commitment to provide flexible, integrated solutions across the entire continuum of care.

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NextGen Healthcare Product Portfolio Supporting Specific MU/PCMH/ACO Criteria

As the core of MU, PCMH, and ACO – the EHR provides the foundation and functionality for practices to achieve Level 3 PCMH recognition. An EHR satisfies not only Meaningful Use requirements, but also provides a long-term solution for the provider’s specialty, workflow, reporting, and other clinical and business needs. The ultimate goal of providers who harness the power of electronic health records (EHRs): Create and share vital patient data across the continuum of care, in real time, and within existing workflows. Also, PCMHs and ACOs require tools that support population management to enable providers to focus on patients with chronic conditions. Beyond simple data exchange the EHR enables providers to improve:

• Provider workflow

• Care coordination

• Patient safety

NEXTGEN HEALTHCARE PRODUCT SUPPORTING FUNCTIONALITY

NextGen Practice Solutions

NextGen Ambulatory EHRand Registry

A solid practice management system is required to reconcile current costs and contracts with payers.

Through a registry and an EHR system, the practice can assess progress in meeting several quality measures.

NextGen Patient Portal and NextGen Health Information Exchange

NextGen® Population Management

NextGen Health Information Exchange

Practices should select an EHR that supports PCMH and ACOwith strong case management and referral management. Physician practices should plan to implement a patient portal and eitherjoin a Health Information Exchange (HIE) or form one of their ownso they can collaborate with other physicians with clinical patientdata integration.

Providers need an intelligent population management strategy to engage in quality programs and proactively reach out to their patient populations to schedule non-compliant patients for recommended care.

Medical practices will need to partner with hospitals, rehabs, skilled nursing facilities, and home health providers to imple-ment results-oriented, integrated care solutions and improved outcomes for individuals, their families, and their local health system. More advanced portals offer the ability for a physician and a patient to engage online for E-visits and consultations. Advanced portals also support connectivity with home health devices – allowing physicians to access and understand “current state conditions” of their client base.


In addition, with NextGen Dashboard, providers can access essential information quickly and easily, and display it in an easy-to-interpret, colorful, and graphical format. If greater detail is needed, providers can drill down from one level to the next with the click of a mouse. This provider-based tool can create graphic images that reflect the priorities of the entire practice or of a single provider.

Dashboard, a Practice Performance Snapshot

ThirdParty

PopulationManagement

Dashboard Layer

CareManagement

InSightReporting™

HQM Regulatory

DataRepository

Equipped with multiple pre-programmed charts, NextGen Dashboard is ready to go at installation, and with its easy-to-use interface, users can quickly create and save their own personal charts.

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NextGen Healthcare and our consultant partners work collaboratively to deliver timely and relevant HIT solutions to our clients. PCMH-ACO, financial

performance, care collaboration, and cloud computing are key initiatives we are targeting.

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ACO Organization Governance/Leadership

ACO Participant Business Operations with IT Alignment Governance

Program Management & Communications

Care Coordination & Quality

NextGen Healthcare supports the ACO market requirements by providing the platform and tools to enhance sharing and data integration across the spectrum of healthcare stakeholders. Above are the current structural requirements of an ACO according to the CMS final rule.

ACO Market Requirements11


ACO Structural CriteriaACO Payers and Medicare Financial Models Payer/provider shared-risk models are in the early developmental stages. The four basic payment risk-sharing models are illustrated below.12

ACO Payers and Medicare Financial Models

NextGen Healthcare and Partner Consulting Services

ACOs are a departure from the status quo and are an ambitious goal for even the most advanced healthcare

systems. But the trend is unstoppable. NextGen Healthcare’s goal is to deliver a completely seamless integration

of solutions across all NextGen Healthcare products. We believe that the only way we can authentically assist our

customers to achieve functioning ACO status is by presenting a broad, flexible, integrated offering across every

stakeholder function in the healthcare ecosystem—and the knowledge to leverage it.

We are doing this with strategic planning and tactical execution while simultaneously providing project

management and supplemental staffing as projects and phases are implemented. Our in-depth knowledge in

EHR, practice management, and acute care workflows and processes will result in significant quality improvements

for our clients and a considerable ROI for our consultant network.

MEDIMEDICCAREAREPRIVATE INSURER EMPLOYER

Risk Sharing

Bonus Payment

Market Share

Baseline Revenue Loss

Patient Population

Provider at risk of not receiving a bonus payment based on quality and/or efficiency performance

Patients given lower copays or premium incentives to select specific providers, risk losing market share

Providers face a financial or payment loss if they fail to meet certain cost or quality thresholds, and/or if actual costs exceed a target cost

Providers manage patient treatment costs for all or a designated set of services within a predetermined payment stream and are at risk for costs that exceed payments

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The Industry’s Vision

Data Exchange, Interoperability, Integration, and Seamless, Secure Access for All

Robust and secure data exchange to external and community information systems at hospitals, labs, pharmacies,

payers, public health, health information exchanges, and patient portals is the critical path that will lead to global

community health. NextGen Healthcare is synchronized with this vision. We provide our customers and the

extended stakeholders within the healthcare ecosystem an innovative solution that supports the patient-centric

model of PCMH and ACO healthcare management.

NextGen® solutions help our clients align with the journey to global community health. Our client

commitment includes working as partners to address the day-to-day challenges of running a successful

practice or hospital system.

Valued Partnerships

As NextGen Healthcare pursues an aggressive agenda in these next years ahead, relationships with clients,

prospects, and industry consultants, will be nurtured to enhance our knowledge and technology innovations

to educate, support, and deliver solutions of the future. We are convinced that our consultant community and

their expansive services portfolio is a critical component for NextGen Healthcare. Together, we can present new

opportunities to create business solutions for success to clients who can benefit from our shared expertise. Our

consultant network also conveys the accurate and up-to-date market intelligence to craft sustainable business

initiatives that position clients for the challenging times ahead.

NextGen Healthcare is one of the most highly sought-after HIT solutions companies in the industry. We believe

NextGen Healthcare consultants are too. Together NextGen Healthcare and industry consultants are creating new

relationships in the market built on thought leadership, superior technology, a track record of success based on

proof, and an unwavering dedication to helping our clients meet today’s industry challenges.

Final Thoughts

The stakes may seem high and the topic of financial solvency is ever-present. The transition involves taking risks,

no doubt, but with focus, a strong technology partner and the right tools, providers can establish sustainable

health care business practices and a strong business model that will keep their doors open and revenue coming

into the practice while they transition to quality care and P4P remuneration. EHRs and other healthcare information

tools are essential to accomplishing this transition. By successfully adopting and utilizing these tools, practices

are better able to identify high-risk patients, provide more comprehensive care, assess clinical outcomes, earn

performance-based compensation, and share information securely both within and outside the practice.

Ultimately, the true long-term revenue and practice rewards will be demonstrated in improved patient outcomes

driven by real-time access to pertinent clinical patient data, anytime, anywhere.


Footnotes

1. Diana Manos, “Mostashari: Meaningful use to reach new heights,” Healthcare IT News, 11 Jan, 2012.

2. Neil Versel, “HIMSS chief forecasts ‘seismic shifts’ for health IT,” Healthcare IT News, 03 June, 2011.

3. Manos, “Meaningful use to reach new heights,” 11 Jan, 2012.

4. Marla Durben Hirsch, “5 EHR predictions for 2012,” Fierce EMR, 5 Jan. 2012.

5. Business Wire, “Cigna and Weill Cornell Physician Organization Launch First Accountable Care Program

in New York City Involving a Physician Organization and a Health Plan,” 11 Jan. 2012.

6. HHS News Release, “Health Policy Brief: Next Steps for ACOs,” Health Affairs Shared Savings Model

http://www.hhs.gov/news/press/2011pres/12/20111219a.html, (accessed 28 March 2012).

7. NCQA, Accrediting Highly-Qualified Accountable Care Organizations,

http://www.ncqa.org/LinkClick.aspx?fileticket=SPg8KYWfK1s%3d&tabid=1312 (accessed 28 March 2010).

8. “Donald M. Berwick,” “Health Affairs,” The Triple Aim: Care, Health, And Cost (online; Health Affairs,

abstract, May 2008, 27), http://content.healthaffairs.org/content/27/3/759, (accessed 28 March 2012).

9. NCQA, “Patient-Centered Medical Home,” PCMH Content and Scoring Summary,

http://www.ncqa.org/tabid/631/Default.aspx, (accessed 28 March 2012).

10. HHS News Release, “Health Policy Brief: Next Steps for ACOs,” (accessed 28 March 2012).

11. CMS, “ Overview,” What’s an ACO? http://www.cms.gov/aco, (accessed 28 March 2012).

12. The Common Wealth Fund, “Newsroom Payment Reform,” Experts Believe Lack of Incentives and

Financial Interests Are Barriers to Integrated and Accountable Care, www.commonwealthfund.org/Publications/

FundReports/2011/Jul/Promising-Payment-Reform.aspx, (Accessed 28 March 2012).

EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Lev-els 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HE-DIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO SSP EHR PM NCQA MSR P4P HEDIS ONC HIE HQM Levels 1,2,3 PCMH CMS MU ACO

NextGen Healthcare Information Systems, Inc.

795 Horsham Road, Horsham, PA 19044

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[email protected] | nextgen.com

Copyright © 2012 NextGen Healthcare Information

Systems, Inc. All rights reserved.

NextGen and NextPen are either registered

trademarks or trademarks of NextGen Healthcare

Information Systems, Inc. in the United States and/

or other countries. All other names and marks are

the property of their respective owners.

Patent pending.

SFS-0001_04/12a QSI company