Why info exchange issues are hampering ACO success

ACOs want to expand capabilities to align providers, services in their communities.

As accountable care organizations (ACOs) work to improve results, they are seeking to expand population health management capabilities, including their relationships with community organizations and patients.

Findings from the report—by Premier Inc., with support from the Robert Wood Johnson Foundation—underscore the need to better share information across a wider continuum of care, including with organizations that traditionally haven’t been included among those receiving patient information. In addition, the findings underscore the need to make better use of analytics to enable ACOs to better quantify approaches that work and those that don’t.

Additionally, results showed that some significant barriers to addressing the social needs of a community have their basis in shortcomings of information technology. These include health record interoperability challenges, mentioned by executives at 74 percent of responding ACOs; and patient engagement, also mentioned by 74 percent.

These insights were published in the first of two reports developed under a grant from RWJF by the Premier Research Institute, a non-profit affiliate of Premier, in conjunction with Greenwald & Associates, LLC, National Research, LLC, and KNG Health Consulting, LLC. The researchers collected qualitative and quantitative information from 19 fully integrated ACOs that participate in Premier’s Population Health Management Collaborative to understand the current state of ACO development and implementation, and identify barriers and potential solutions.

Also See: 30 of the nation’s largest ACOs

“Alternative payment models, such as ACOs, serve to shift the traditional fee-for-service model, which incents providers to do more rather than do better, to a value-based model that aligns incentives with measurable quality, cost and population health outcomes,” said Timothy Lowe, PhD, director, healthcare research, Premier Research Institute, the study’s principal investigator. “As providers develop and implement alternative payment models to align with value-based payment policies, such as the new Quality Payment Program for physicians, it is critical to identify what is working and what is not to support continuous change and improvement.”

Review of the qualitative findings yielded a number of overarching themes that capture opportunities, challenges and outcomes as organizations develop and implement ACOs. For instance, while nearly every ACO studied is working with community social service organizations, 84 percent cited increased support from their community partners as an opportunity for improvement that is very different from the work that hospital-based organizations have traditionally considered. This includes moving to serve as the central hub to enable community organizations to be more effective in meeting the needs of mentally ill and chemically addicted residents, as well as teaming with employers and local gyms to offer exercise and nutrition-based counseling to address preventative health needs.

"Increasingly, providers understand how important the things that happen outside of the doctor's office or hospital are to improving and managing a person's health,” said Andrea Ducas, program officer at RWJF. "To that end, some leading ACOs are expanding their services to include more upstream, preventive support for patients and are also expanding their work to reach entire communities, rather than just focusing on their assigned beneficiaries.”

“What can get lost in discussions is the impact of the social determinants of health on how well ACOs perform,” said Joe Damore, vice president of population health management at Premier. “This analysis reveals real-world efforts underway when it comes to the importance of community partnerships to influence health outcomes and performance. We’re seeing our members collaborate with organizations like Meals on Wheels to improve the health of their populations.”

However, there are different levels of maturity among ACOs. Some are struggling with financial pressures and payer requirements related to the specific populations for which they are accountable. Only 32 percent of respondents reported that their communities had adequate resources to meet the challenge of improving community health. Limitations include, inadequate funding for staffing and services, data interoperability challenges, physicians operating under the fee-for-service model, and payer pressures.

“These limitations have obvious implications for healthcare policy and restrictive reimbursement frameworks, including providing the resources and funding to address the basic clinical, social, and psychological needs of patients,” Lowe says.

Researchers also identified three ways ACOs are engaging to meet the ongoing and future challenges of population health and value-based payment models:

• Improving information and best practice sharing with other ACOs.

• Developing a framework for implementing population health improvement activities based on level of maturity and access to required community resources.

• Enhancing dialogue between providers, regulators and funders to set priorities for services development and future research foci.

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