Providers are facing myriad challenges developing accountable care organizations (ACOs), finding no easy solutions on the market today to scale and successfully perform the population health management necessary for these complex risk arrangements, said IT industry leaders who participated in a panel that tackled the strategic IT issues surrounding ACOs at the Healthcare Informatics Executive Summit in May.
Sam Van Norman, director of business intelligence, Park Nicollet Health System, one of the panelists participating in the “ACOs: Policy, Strategic, and IT Issues” panel, for one, has had to make it work with what his St. Louis, Minnesota-based healthcare system has in terms of IT infrastructure in order to move forward with its CMS Pioneer ACO. The ACO panel was among the many discussions at the HCI Executive Summit in Orlando, Fla.
“Since there is not something that does it all for us, we’re going to have to build it—whether that means simply from a variety of other sources, or from scratch—and that’s wrong,” said Van Norman. “That is a terrible position for us to be in as a provider organization. Our competency is taking care of people, it’s not developing software packages.”
Park Nicollet has engaged its research institute to create a daily readmission prediction model that performs risk stratification and that scores patient utilization, with those identified patients then handed off to care managers to engage. Van Norman said that his system has chosen not to wait for further IT implementations and is making do with the systems they have, which means falling back on paper processes. Van Norman said that more organizations like his are coming to these kinds of conclusions, and he challenged consultants and developers to build scalable systems for providers to manage their patient populations.
The cultural change piece that is necessary for providers to implement an ACO is another challenge Van Norman sees, which involves team-based care and treating the whole patient, rather than the individual condition. Jeffrey Rose, M.D., vice president of clinical excellence of informatics at Ascension Health, agreed that today’s providers are actually disincentivized from doing the right thing to treat their patients and that it’s problematic to apply IT to a broken healthcare system. Rose, who is helping to lead his 81-hospital integrated healthcare system, located in St. Louis, forward with its CMS Pioneer ACO and other accountable care initiatives, said it’s been a challenge to link up individual IT efforts to treat patients and also make responsible decisions for the population at large.
The need for vendors to develop ACO solutions for the future is keenly felt by many in the industry, including the Premier Health Alliance, a coalition of 2,500 hospitals, said Jeff Petry, vice president of strategic initiatives for Premier. Petry said the organizations that are currently investing the most money in ACO creation, however, are payers. These arrangements, like Aetna’s hospital-centric efforts and Cigna’s physician-driven collaboratives, are claims-based, rather than fueled by clinical data.
Rose is dubious about the role of payers in accountable care development, and said they present a “cognitive dissonance” in their focus to pay doctors faster for their efforts to save money and reduce unnecessary testing. The focus, Rose said, should be on managing the health of the population and preventing readmissions, in addition to reducing unnecessary testing. “The payers are never going to be able to intervene at the point-of-care with good clinical data to help you do the right thing as a provider, based on the population you’re taking care of,” he said.
There are three starting points for ACO IT strategy, Petry suggested. First, he recommended that an organization must understand where its risk lies, and realize that when assuming risk, whether it’s shared savings, bundled payments, or a capitation model, only a small percentage of the patient population generally drives the majority of costs.
Another starting point is to create a model to identify the high-risk and most costly members, predict who those patients are in the future, and identify what the care gaps are to manage those members, said Petry. He added there were commercial tools in the market today, but tailoring them for the provider community would be the challenge. The third key for a successful ACO is to focus on patient engagement to encourage patients and their families to take accountability for their own healthcare decisions.
Petry said that many in the industry are hedging their bets, with no one “knowing which [risk] model is necessarily going to work yet,” but he said the industry has “to keep pressing ahead and testing what works in our own markets.”
“You can’t sit back and do nothing. I think that’s the most dangerous thing,” said Petry. “If you look at what the federal government is doing. They are hitching their bets across a lot of different reimbursement and care delivery models that stand different levels of risk shifting to the provider community, and they’re waiting to see what can really be scaled and what works in different markets.”