If accountable care organizations are to succeed in achieving financial, clinical, population health and risk management, they need a strong health IT infrastructure and the ability to exchange health data across disparate systems and settings.
That’s the finding of a new ACO issue brief from the Workgroup for Electronic Data interchange, which describes the basic structure, operation, and activities of ACOs, fleshing out some of the key challenges they must overcome.
“A successful ACO has got to have a very strong HIT infrastructure and platform and be able to communicate with lots of different systems,” says Michelle Templin, co-chair of WEDI’s Alternative Payment Models Workgroup.
ACOs require a robust health IT infrastructure that can support activities related to quality measurement, population health management, physician payment and contract adjudication. Yet, many continue to use basic HIT for documentation and coordination of care, with few employing advanced capabilities, according to Templin.
And, with the Department of Health and Human Services’ announcement earlier this year that it intends to tie 30 percent of traditional fee-for-service Medicare payments to quality or value through alternative payment models such as ACOs by the end of 2016, she says the stakes are getting higher.
For ACOs to compete and thrive in this kind of environment, WEDI argues they must “adopt technologies fully capable of executing complex, multivariate analysis that can yield actionable results for improvements in quality, costs and service.”
Alternative payment models such as ACOs are meant to improve quality and health outcomes while reducing the cost of care, Templin says, but these organizations continue to struggle with implementing HIT and health information exchange. Accessing data from external organizations continues to be a significant challenge, she asserts.
The WEDI brief identifies the key components that ACOs need to accomplish their performance goals. These include a formal ACO organization, risk and financial management structures, health IT infrastructure, data measurement, reporting and analytics, and population health management.
As WEDI points out, effective population health management “can help target and prioritize resources towards those in greatest need, reduce disparities and streamline evidence-based guidelines of care,” but PHM is “extremely resource-intensive and requires dedicated personnel and technology solutions that can optimize care management, coordination and reporting.”
In addition, WEDI finds that most ACOs are not currently able to seamlessly push or pull complete patient health data in an accessible and timely manner. “Until they are able to do so, many organizations will find themselves fundamentally handicapped in their ability to meet operational objectives,” the brief concludes.
“We’re trying to help them drive toward that objective in a scalable way that can be used by both smaller and larger ACOs,” adds Templin.
To evaluate the progress of ACOs in tackling these challenges, WEDI is continuing its ongoing survey of these organizations, who are encouraged to participate. The 2015 survey, which focuses on ACO demographics, IT infrastructure, contracting options, financial risk models and clinical management tools, can be found here.
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