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Turning Around the Ship of U.S. Healthcare in Mid-Ocean: What Are We Learning about Mastering the Data Integration Challenges?

September 12, 2015
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The results of a recent ACO survey affirm what our reporting continues to uncover: vast data integration challenges in ACO development

As HCI Senior Contributing Editor David Raths noted in his September 8 report, a recent survey of 69 accountable care organizations (ACOs) by the eHealth Intiative and Premier, Inc. found that ACOs continue to struggle with accessing data from outside their organizations, and with integrating data from disparate sources.

The survey, conducted in August, “asked respondents about the type of data they collect and what they are using it for. The survey found that ACOs most often analyze claims data (96 percent) and clinical data (79 percent), followed by administrative data (52 percent), disease registry data (39 percent), and patient-reported data (38 percent). They reported working to identify gaps in care (84 percent); identify outliers in cost/utilization (80 percent); compare clinician performance (77 percent); measure/report on quality (77 percent); and proactively identify risk (68 percent),” Raths reported.

What’s more, he noted, “Survey respondents reported having programs to address specific high-cost or high-utilization patient populations (84 percent); care transitions management/care coordination programs (82 percent); disease-management programs (73 percent); post-discharge programs (68 percent); evidence-based clinical/care guidelines (55 percent); and medication management programs (38 percent).”

And in his report, which included his coverage of a panel discussion in a webinar on the topic of the survey, David quoted Kevin Attride, director of clinical health outcomes at AMITA Health, an ACO and clinically integrated network in the western suburbs of Chicago, as noting that the survey highlights the difficulty providers are having in transitioning from fee-for-service to value-based care, with many providers having one foot in both canoes. “Health IT is one of the biggest hurdles,” Attride told webinar participants. “It takes more than claims data. We have all these silos we are attempting to break down, and it is cultural. We are trying to integrate as many systems as we can,” he said, but because AMITA is in a heterogeneous network and without a strong health information exchange in its region, he said it was “hamstrung a bit.”

Meanwhile, Craig Richardville, senior vice president and chief information officer at 39-hospital Carolinas HealthCare System, told webinar listeners that the survey results were not that surprising, given that the healthcare industry has been automating processes in siloed environments such as the acute-care setting, and that the next steps in the maturity model would involve better ways to share and consume data as well as patient engagement strategies that break out of tethered patient portals. “We are in the infancy stage of any type of maturity model, but we need to grow up because healthcare financing changes are moving so quickly we need to get better at it,” Richardville noted. “As we move into the ACO environment, it will enhance and accelerate connected models such as remote monitoring, patient-generated data and mobility solutions.”

What’s clear in all this is that all the old processes in healthcare—billing-driven data entry and capture, ridigly siloed data capture and storage, lack of interoperability, and very broad breakdowns in communication and coordination between health plan payers and hospital and physician providers—are deeply entrenched in the U.S. healthcare delivery system, and are continuing to make it difficult for accountable care organization development to move forward as rapidly as anyone would like it to.

I am seeing these kinds of statements of frustration with the ability to truly marry clinical and claims data, apply robust data analytics to all that data, and successfully leverage the data and the analytics together to help improve care management and care delivery processes, and engage in the “blessed cycle” of data collection, data analysis, data-sharing with end-user clinicians, care delivery process continuous improvement, and further data collection, etc., in a continuous loop of efforts and initiatives. Indeed, every single healthcare and healthcare IT leader I’ve interviewed around the subjects of accountable care, value-based care delivery and payment, population health management, and care management, has expressed extremely similar frustrations.