Beacon Community Programs had “mixed progress” on health information technology (IT) use and quality measures during the past four years, according to a new report from the National Opinion Research Center (NORC) presented to the Office of the National Coordinator for Health Information Technology (ONC).
The report summarizes the findings of NORC’s four-year study of the Beacon Community Program and the authors of the report found that Beacon communities were generally successful on two fronts – performance metrics and sustained health information exchange (HIE) infrastructure.
According to the study authors, Beacon communities’ success “tied to the extent to which communities leveraged existing efforts and engaged providers.”
“Likewise, Communities varied in the degree to which they collaboratively sustained their investments in shared resources for HIE following the end of Beacon funding,” the report states.
According to the study, communities also found their efforts hindered in critical ways by challenges stemming from provider readiness, legal and policy constraints, and the technologies used.
In 2010, ONC established the Beacon Community Program, as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted under the American Recovery and Reinvestment Act of 2009 (ARRA). Under the program, ONC awarded $250 million across 17 diverse Communities throughout the country, to build and strengthen their health IT infrastructure in support of clinical transformation efforts.
The goals of the program were to improve health care quality and outcomes while lowering the overall cost of care by building and strengthening health IT infrastructure and exchange capabilities within communities and using investments in health IT to achieve measurable improvements in cost, quality, and population health. Another goal was developing innovative approaches to performance measurement, technology, and care delivery to accelerate evidence generation for new approaches.
In 2011, ONC funded NORC at the University of Chicago (NORC) to design and conduct a four-year independent evaluation of the Beacon Community Program to assess their progress in building and strengthening their health IT infrastructure and leveraging this infrastructure to achieve clinical transformation.
Healthcare Informatics has profiled a number of Beacon Communities and recognized the Crescent City and Colorado Beacon Communities in particular with Innovator Awards in 2013 for their respective projects that have advanced health IT infrastructure. The Crescent City Beacon Community (CCBC) initiative in New Orleans, Louisiana was award a $13.5 million grant over three years as one of the 17 Beacon communities nationwide and used this funding to initiate the creation of a metro area-wide patient centered medical home (PCMH) model.
In an interview with HCI Editor-in-Chief Mark Hagland, Anjum Khurshid, M.D., director of the Louisiana Public Health Institute’s (LPHI) Health Systems Division, said LPHI leaders identified two areas to work on as a Beacon community.
“First, we wanted to demonstrate the capability of quality improvement at the community level; and we also wanted to make long-term investments in the healthcare system, because we knew that three years wasn’t enough to do everything—but it was enough to set up a foundation that would create a patient-centered, accountable, community-wide focus for care, irrespective of whoever the payer is,” Khurshid said. Indeed, he said, “That’s the issue for a lot of communities; we’re spending a lot of money on healthcare, but we don’t necessarily think of the population as a whole, and we don’t think of healthcare as a common good that is shared by everyone. So the Beacon funding helped us to do that.”
In the interview, Khurshid said one particular area of focus was improving communications between and among clinicians and administrators in all the settings of care in the community, from physician offices and clinics to emergency departments to inpatient hospitals. The CCBC initiative funded the deployment of care managers, who are working with the 160 physicians staffing 20 federally qualified health centers (FQHCs) in the metro area. And those care managers are making use of two critical IT elements to improve communications: a community-wide HIE sponsored by the LPHI/CCBC, and the deployment of electronic health records (EHRs) by physicians at all 20 FQHCs. Khurshid said the community-wide HIE ensures that primary care physicians receive information regarding patient hospitalizations, ED visits or specialty care visits.
With regard to challenges facing Beacon Communities, and specifically technology challenges, the NORC study found that Beacon communities encountered infrastructure and technical issues with limitations in EHR developers’ capabilities and costs.
“Unexpected limitations in EHR developer capability often delayed the implementation of technology solutions for Beacon Community interventions,” the report states. And, the report notes that the “costs of health information exchange often acted as barriers, particularly for smaller independent practices that lacked the necessary resources and infrastructure to support Beacon efforts.”
The NORC study also found that Beacon Communities encountered challenges with provider engagement.
“Providers also had difficulty focusing on meeting Beacon intervention requirements in light of other— often competing—initiatives,” the report states. “In addition, recognizing the importance of sharing best practices between providers and the power of peer-to-peer learning, many Beacon Communities developed Community- wide approaches that engaged participating practices around a common quality improvement curriculum.”
The report also noted that Communities also used “widely trusted local organizations and individuals to serve as Community leaders and facilitate engagement of providers and other stakeholders.”
The study authors wrote, "Participating providers’ familiarity with and use of existing technical infrastructure proved an important enabler in supporting Beacon’s clinical transformation efforts. In addition, experience gained by participating in preexisting regional initiatives helped advance clinical transformation projects, particularly those aimed at quality improvement and stakeholder engagement."
Beacon Communities profiled by HCI have noted similar lessons learned. In Louisiana, Khurshid with the LPHI’s CCBC said physician collaboration and the intensive participation of physician leaders in the community played a critical role in that Beacon Community’s efforts to leverage healthcare IT to support its community-wide initiative.
The study report findings suggest important considerations for future program design, evaluation, and policy:
- Programs intended to demonstrate meaningful impact on cost, quality, and health outcomes require sufficient time to become operational and demonstrate results.
- Support in aligning regional efforts with federal initiatives will foster continued progress and sustainability of investments made under the Beacon Program.
- Providers, health systems, and health plans would benefit from analyses that demonstrate the need and return on investment for performance measurement and electronic data exchange, as market dynamics and shifts in policy priorities affect their willingness to engage.
- The apparent inability of the private sector to achieve interoperable systems suggests the need for national leadership to support their creation.
- Claims data alone are limited in their usefulness in demonstrating the true impact of programs comprising diverse interventions that are refined over time.