A Chicken-Or-Egg Conundrum: Will Your IT Capability Be a Limiting Factor in ACO Development?

April 10, 2013
A recent industry survey highlighted the possibilities and pitfalls in creating ACOs, and the potentially scope-limiting factor of any collaborative's information technology resources in moving forward on accountable care delivery and financing

Recently, the Healthcare Intelligence Network surveyed leaders of 200 healthcare organizations involved in the development of accountable care organizations (ACOs). A number of interesting results came out of that survey, among them:

> With regard to the amount of time needed to create an ACO model, 40 percent of respondents said it took a year or less to create the model; 33 percent said one year to 18 months; and 16 percent said 18 months to two years.

> When asked who was running the ACO, 24 percent said physicians were running the ACO; 20 percent said health plans; 14 percent said a physician-hospital organization (PHO); 7 percent each said an independent practice association (IPA), a payer-provider cooperative, or an independent organization; and 5 percent said a hospital.

> The biggest challenges cited by survey respondents to ACO development were staff buy-in, technology, cost, and clinical integration.

> The biggest benefits cited were care coordination, evidence-based care, patient satisfaction, physician and payer alignment, and creation of a common data platform.

Overall, these findings confirm what we at Healthcare Informatics have been hearing from leaders in U.S. healthcare, with regard to the challenges, opportunities, and complexities of this area.

What is particularly fascinating to me about all this is the interplay between the strategic organizational elements of ACO development and the strategic IT elements. Of course it goes without saying that any group of individuals that comes together with the intention of creating and developing an ACO—whether under the Medicare Shared Savings Program, or in collaboration with a private health plan—will need to have a raison d’être, a broad, strategic purpose for developing this novel payment and delivery model, before they make their first steps towards implementation.

The articulation of that broad strategic purpose should absolutely frame the terms of engagement around data and information technology. Yet in the real world of healthcare operations, the tools one has or is already building so often shape what is possible. It’s a bit like a community coming together to build a new community center and wanting to build a $50 million showcase complex, only to find that only half of that, at best, is currently available.

So it is absolutely clear that healthcare IT leaders—CIOs, CMIOs, vice presidents of clinical informatics, CTOs, et al—will play an incredibly important collective role in these ACO development discussions. These leaders will be needed to help their colleagues—the senior executive and senior clinician leaders—of these collaboratives understand what is possible and what is not, what is doable and what is not; and they will in turn need to stretch their leadership capabilities to help their colleagues make the most of their IT and human resources to create the collaborative care models that can best succeed going forward.

It all really is a bit of a chicken-or-egg conundrum in some ways, because if one accepts one’s present resources as limiting factors, one could easily shortchange one’s vision of collaborative care delivery. On the other hand, overreaching has already proven the downfall of many a highly admirable concept in healthcare; just look at the RHIOs (regional health information organizations) that failed and had led to the creation of a newer acronym, HIEs (health information exchanges), because of the volume of RHIO failures several years ago.

This is clearly a time of change and challenge in healthcare; what to me seems equally obvious is that those organizations and collaboratives whose leaders have that perfect combination of strategic vision and concrete practicality needed to create successful ACOs (not to mention also successful bundled-payment contracts, successful HIEs, and successful value-based purchasing arrangements) will succeed in their local and regional healthcare markets, and even more importantly, point the way to the future. And their strategic IT thinking will be as powerful as their overall strategic thinking, and will pave the way for their colleagues nationwide. Challenging? Doubtless. Possible? Absolutely.

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