FQHCs Are Eligible to Become ACOs
This is a great opportunity for Accountable Care Organizations (ACOs) to take advantage of and partner with Covered Entities that are eligible for 340B drug pricing. Although there is a great deal of talk about ACOs, there is still much to be done to put all the pieces together; integrating systems, establishing data warehouses, and creating business intelligence rules to aid in data mining. With that said, some clarifications and changes came in the last week when the final rule was published which differs in seven areas from the proposed rule. The best news was that there were additional groups recognized to both be eligible to form and to participate in an ACO, which are federally qualified health care centers and rural health clinics.
One of the most surprising was that no longer is the electronic health record a condition for participation. Previously 50% of primary care physicians were to be defined as meaningful users by the start of the second performance year. Although this changed, the E.H.R. was retained as a quality measure and is rated higher than other measures for quality scoring purposes. There were also modifications to contacting beneficiaries from quarterly lists to notify them of data sharing and an opportunity to decline which previously only allowed data sharing of claims data for patients seen by ACO primary care physician during the performance year with beneficiaries given the opportunity to decline at POC.
Other areas which changed in the final rule were the start date which allows much more flexibility, aggregate reports-additional reports will be provided unsure what these are yet, assignment process changing from a one step to a two step process and marketing guidelines new file and use which is a less cumbersome process. To learn more about pharmacy benefits management, follow our blog at CaptureRx.
Holly E. Russo, RN, MSN, MS, ECS
Vice President Hospitals and Health Systems, Chief Clinical Officer