Connected Care Is Key to Accountable Care: The Case for Supporting Telehealth in ACOs | Page 2

Published Online: June 20, 2014
Krista Drobac, executive director, Alliance for Connected Care, and Clif Gaus, president and CEO, National Association of ACOs
Allowing ACOs to be reimbursed for Connected Care technologies will further the goals of the ACO program by providing additional tools to improve quality and reduce costs. Furthermore, it is consis- tent with the language of the Affordable Care Act (ACA), which directed ACOs participating in the Medicare Shared Savings Program to “define processes ... to coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.”5 To that end, in the final regulations for the program, CMS indicated that it wanted to give ACO providers the flexibility to choose those tools that best facilitate care coordination for their practitioners and patients.6 However, this is not the case under the current statutory and regulatory framework.

Fortunately, the Secretary has the tools in place to address these barriers. Section 1899(f) of the Act gives the HHS Secretary the authority to “waive such requirements of sections 1128A and 1128B and title XVIII of [the] Act as may be necessary to carry out the [program].”7 Separate from the waiver authority for the Center for Medicare and Medicaid Innovation demonstration projects, this authority applies only to ACOs. To date, this authority has been used to grant 5 waivers to the fraud and abuse laws and to the timing of ACO repayment for shared losses.8 The waiver of the 1834(m) restrictions is equally critical to achieving the success of ACOs and can be done without waiting for Congress to act.


Connected Care technologies can help achieve the core goals of ACOs and should be widely deployed. Although there is already evidence of its success in improving care and reducing costs, the current operational structure of the healthcare system makes investment in Connected Care technologies without reimbursement difficult, even for ACOs. The authority exists within HHS to waive the restricting language that limits reimbursement of telehealth to rural areas for ACOs. HHS should use its authority to lift those restrictions so more ACOs can serve patients with technology that will improve care and patient satisfaction, while lowering costs.

Author Affiliation: Krista Drobac, executive director, Alliance for Connected Care, Washington, DC; Clif Gaus, president and chief executive officer, National Association of Accountable Care Organizations.

Address Correspondence to: Associate editorial director Nicole Beagin: nbeagin@ajmc.com; 609-716-7777 ext. 131.
1. The Revolving Door: A Report on US Hospital Readmissions. Robert Wood Johnson Foundation website. http://www.rwjf.org/content/dam/farm/reports/re- ports/2013/rwjf404178. Published February 2013.

2. Usher-Pines L, Mehrotra A. Analysis of Teladoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff (Mill- wood). 2014;33(2):258-264.

3. Dixon RF, Rao L. Asynchronous virtual visits for the follow-up of chronic condi- tions [published online May 2. 2014]. Telemed J E Health.

4. Section 1834(m) of the Social Security Act, 42 USC §1395m(m).

5. Section 1899 of the Social Security Act, 42 USC §1395jjj.

6. 76 Fed. Reg. 67802 (Nov. 2, 2011).

7. Section 1899(f) of the Social Security Act, 42 USC §1395jjj(f). 

8. 76 Fed. Reg. 67992 (Nov. 2, 2011) and 76 Fed. Reg. 67802, 67941 (Nov. 2, 2011).
Issue: June 2014
More on AJMC.COM