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.
At a very fundamental level, what is being made clear is that shifting the overall U.S. healthcare delivery and reimbursement system from a volume-based, fee-for-service-incented system to a value-based, outcomes-driven system, is turning out to be far more difficult than perhaps anyone even anticipated. U.S. healthcare delivery and payment processes are almost entirely predicated on volume and on fee-for-service payment, down to the ways in which we collect data, which, let’s face it, are extremely reimbursement-driven rather than overwhelmingly clinically driven. When one compares the clinical information systems of the western European healthcare systems with single-payer payment systems to that of the U.S. healthcare system, there is simply no comparison. Because providers operating within those single-payer systems have no need to expend tremendous amounts of time, energy, and money documenting tasks performed in order to get paid, the administrative burdens they place on physicians, nurses, health information management professionals, IT professionals, administrators, and everyone else, are miniscule compared to ours, and they can focus on making changes that purely focus on the patient care needs of their communities and societies.
Still, our very predicament—the need to turn around a gigantic, $3 trillion-a-year-plus-spending, nationwide healthcare system “ship” in conceptual “mid-ocean”—is also leading to tremendous outbursts of ingenuity, as providers, payers, programmers, vendors, and everyone else, are all racing forward to develop innovative ways to create innovation going forward into the new healthcare.
And when ACO leaders move with decisiveness to leverage analytics and other IT solutions to pinpoint their issues and evolve their organizations forward, the results can be quite heartening, as I noted in my September 8 blog about the advances that the Premier ACO Collaborative’s member organizations are making these days.
In the end, it is going to be a precisely skilled combination of focusing on strategy, process improvement, robust data collection and data analytics, and really good, roll-up-your-sleeves collaboration among all stakeholder parties, that will help the leaders of some ACOs become the most successful. Yes, this is incredibly challenging work; but as a glass-half-full person, I believe we’re starting to see the first “green shoots” of effort showing themselves now (and my apologies for the wild mixing of metaphors in this sentence). Because yes—to add yet one more metaphor to this paragraph, turning the massive ship of the U.S. healthcare system around in mid-ocean is indeed a daunting proposition: but at the individual-ACO level, healthcare leaders in pockets all across the U.S. are showing that it can be done.