Health IT Helps ACOs, but Core Challenges Remain, OIG Report Finds

May 30, 2019
ACOs that use multiple EHR systems have had trouble coordinating care compared to those that use a single platform

Health IT tools such as electronic health records (EHRs) have enabled accountable care organizations (ACOs) to better coordinate patient care, but several IT-related challenges still remain, according to a recent analysis by the Office of Inspector General (OIG).

The OIG, an agency within the U.S. Department of Health and Human Services (HHS), studied six Medicare ACOs with the goal to provide insights into how select ACOs have used health IT tools to better coordinate care for their patients. The researchers stated, “It can help ACOs anticipate challenges they might face, and it can help the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT(ONC) assist ACOs in overcoming those challenges. Health IT has significantly enhanced providers’ opportunities to coordinate patientcare across healthcare settings.  Medicare patients often have chronic medical conditions that require care from multiple providers. Care coordination helps ensure that patients’ needs for health services are met over time and across multiple encounters and settings.”

The ACOs that were visited by OIG range from having 7,000 Medicare beneficiaries to 72,000. Each had at least six years’ experience as a Medicare ACO; four were in the Next Generation model and two were Medicare Shared Savings Program (MSSP) participants.

The analysis revealed ACOs that used a single EHR system across their provider networks were able to share data in real time, enhancing providers’ ability to coordinate care. What’s more, a small number of ACOs had access to robust health information exchanges (HIEs), which give ACOs access to patient data even when patients see providers outside the ACOs’ networks. And, most of the ACOs that OIG visited used data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions.

That said, the researchers acknowledged that many IT-related challenges still do exist. For one, they noted, ACOs that used multiple EHR systems had to rely on other means to share data among providers, either using additional health IT tools or relying on phone calls and faxes. “ACOs report that EHRs can also be burdensome and frustrating for providers,” they stated, further noting that “Providers in one such ACO’s service area cannot easily share data electronically, even when using the same EHR vendor, because they have different versions of the EHR software.”

To this end, ACOs also faced challenges from physician burnout due to the workload of managing EHRs, the study found.  Most of the ACOs had access to health information exchanges, but some of those HIEs had little or incomplete data, making it difficult to coordinate care when patients saw providers outside the ACOs’ networks, researchers said. For instance, one ACO used two HIEs, each of which covers part of the ACO’s service area. The ACO helped to develop one of these HIEs. Both HIEs offer alerts on admissions, discharges, and transfers, as well as tracking of prescription drugs.

But in other cases, this was not the case. A few of the ACOs that were studied have access to statewide HIEs, for example, but did not find them useful either due to the HIE’s lack of provider adoption and concerns about the accuracy of its data.

Regarding data analytics, most of the ACOs that were visited use population-level analytics to identify and group patient populations according to the potential severity and cost of their health conditions, otherwise known as risk stratification. Finally, few ACOs offer health IT tools to patients, other than online portals to their EHRs, the report found.

The OIG report concluded, “The ACOs we visited have used health IT to aid in care coordination in a variety of ways.  However, the full potential of health IT has not been realized. ACOs vary in the extent to which they can rely on health IT tools, in some cases because those tools cannot reach all providers involved in a patient’s care, or because the tools lack the necessary information that ACOs need.”