Accountable care organizations (ACOs) continue to struggle with gaining access to data outside their organization and with data integration. An August 2015 survey of 69 ACOs by the eHealth Initiative also found change management and the cost of new health information technology among key challenges.
The third annual ACO survey by eHI in conjunction with Premier Inc. 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%) and clinical data (79%) followed by administrative data (52%) disease registry data (39%) and patient-reported data (38%). They reported working to identify gaps in care (84%); identify outliers in cost/utilization (80%); compare clinician performance (77%); measure/report on quality (77%); and proactively identify risk (68%).
Survey respondents reported having programs to address specific high-cost or high-utilization patient populations (84%); care transitions management/care coordination programs (82%); disease-management programs (73%); post-discharge programs (68%); evidence-based clinical/care guidelines (55%); and medication management programs (38%).
In a webinar panel session discussing the survey results, Kevin Attride, director of clinical health outcomes at AMITA Health, an ACO and clinically integrated network in the western suburbs of Chicago, said 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, Attride said. “Health IT is one of the biggest hurdles,” he said. “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.”
Craig Richardville, senior vice president and chief information officer at 39-hospital Carolinas HealthCare System, said the survey results were not that surprising. He said the 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,” he said. “As we move into the ACO environment, it will enhance and accelerate connected models such as remote monitoring, patient-generated data and mobility solutions,” he said.
Bryan Bowles, vice president, solutions marketing for population health at Premier Inc., which works with 70 ACOs in a collaborative, said the survey’s finding that access to data from outside their organization and integrating that data in a meaningful way is no surprise. Building those data models and operationalizing them in workflows has proven to be a real challenge, he said. “We also have seen a shortage of employees with data integration or modeling experience to pull the data together so you can trust it and have it make sense at the point of care,” Bowles said.