Survey: ACOs Still Cite Lack of Interoperability as Biggest Barrier

Jan. 21, 2016
A recent survey of 68 accountable care organizations (ACOs) found that despite steep investments in health information technology (HIT), ACOs still face interoperability challenges that make it difficult to integrate data across the healthcare continuum.

A recent survey of 68 accountable care organizations (ACOs) found that despite steep investments in health information technology (HIT), ACOs still face interoperability challenges that make it difficult to integrate data across the healthcare continuum.

The survey, from the Charlotte, N.C.-based Premier, Inc. and the Washington, D.C.-based eHealth Initiative (eHI), found that integrating data from out-of-network providers was the top HIT challenge for ACOs, cited by nearly 80 percent of respondents. Nearly 70 percent reported high levels of difficulty integrating data from specialists, particularly those that are out-of-network.

 In addition, the more settings of care and number of providers a patient sees, the less likely it was that their data was sent back to the primary care team responsible for coordinating care. More than half of surveyed ACOs report they have not yet been able to integrate any data from behavioral health providers. In addition, 48 percent reported no integration with long-term and post-acute care settings, followed by palliative and hospice facilities (46 percent).

The 2015 ACO survey from August consisted of 19 questions, including demographic data about the ACO, their HIT infrastructure, measures of interoperability, integration, and data use and related challenges. Survey respondents included a mix of Medicare and commercial ACOs. Last year, the Premier, Inc. and eHealth Initiative survey found similar results; although most ACOs have the health IT in place to improve clinical quality, poor interoperability across systems and providers remains their biggest barrier, according to the 2014 ACO survey.

Despite the hurdles, many ACOs have been able to start capturing and using data from sources within their networks. Nearly 85 percent of respondents report they have in place advanced analytics software to analyze disparate data sets. The most commonly used data sources include adjudicated claims data (96 percent), followed by clinical data from electronic health records or other quality measurement systems (76 percent). Less common data sets include administrative data (52 percent), disease registry data (39 percent) and patient reported data (38 percent). ACOs report using the data to identify gaps in care (84 percent), spot outliers in cost/utilization (80 percent), compare clinician performance (77 percent), measure/report on quality (77 percent) and identify areas of potential risk (68 percent).

What’s more, ACOs report use of additional health information technologies to support network operations. Most prevalent are electronic health records (EHRs) (74 percent), care management software (61 percent), computerized physician order entry (57 percent) and a data warehouse (55 percent). Nearly half of ACOs are also using other tools to facilitate population health management, including integrated claims and clinical databases (48 percent) or a population health dashboard (44 percent) that providers can use to visually compare performance. However, despite the potential of telemedicine for collaboration and communication, relatively few ACOs currently use the technology (26 percent). And fewer still utilize remote monitoring tools (16 percent) to facilitate care management outside of clinical settings, according to survey data.

“These results are not surprising. We know that it’s relatively simple for providers within the same organization using the same systems to share information about their patients,” said Jennifer Covich Bordenick, CEO of eHI. “The real challenge is successfully moving and integrating that data across dozens of different systems, and we’ve found that out-of-network practices often lack the proper incentives to make investments in the data sharing agreements and interoperable interfaces necessary for success. This lack of liquid data is creating dry spots in care delivery, making it difficult for ACOs to proactively intervene with needed care. Until HIT systems across the continuum can exchange data freely, we handicap ACOs in their quest to achieve healthcare’s Triple Aim of better health outcomes, quality and costs.”

On a Jan. 20 press call discussing the survey results, Mimi Huizinga, M.D., vice president and chief medical officer of Premier’s Population Health Management Collaborative, admitted that it would be great if providers or patients could log in and see a complete record, but the industry isn’t quite there yet. “The systems were designed to operate independently, so they haven’t been fully deployed [in terms of what we need them to do], but we are making progress,” she said.

Also on the call was Joel Vengco, vice president and CIO, Baystate Health (Springfield, Mass.), which has been operating in a pay-for-value environment for the last five years, and is one of the 21 ACOs who will be part of CMS’ Next Generation ACO program, of which details were recently announced. “We’re putting our money where our mouth is, we’re sharing risk, and we’re understanding how to deal with pay-for-value,” he said. Vengco noted the obvious benefits of interoperability including seamless EHR interoperability, analytics and action, and greater opportunity for innovation. “You cannot have true knowledge and insight of data without the ability to aggregate, standardize, and normalize it,” he said. “Retrospective reporting is the first step in analytics, and then comes predictive modeling and forecasting. If someone comes into the ED, we want to be able to understand that, based on other patients like this, or based on the patient’s history, what type of setting should he or she should go to next. Predictive modeling is crucial for ACO management,” he said.

Vengco dove into more interoperability challenges, noting that data in technology systems is currently locked, which is not always a technical issue, but sometimes a choice by vendors, as he puts it. “We are trying to solve those issues via certifications and meaningful use rules that are being pushed out,” he said. However, high costs are a detriment not only for health systems like Baystate, but also to patients who expect the highest levels of care, Vengco said. As such, he called for the publishing of standards-based, interoperability requirements upon vendors that enable innovation and evolution. He said that meaningful use and other regulatory mandates should be market-driven, and usability and adoptable workflows of providers should be considered more.

Following Vengco on the call was Alex Kontur, manager, research and projects, eHealth Initiative, who dove deeper into the survey’s results. Kontur noted that ACOs are not yet phasing out fee-for-service (FFS) methods, pointing out that based on the survey data, payment models typically still remain FFS-oriented, limiting risk to the ACO. Indeed, just 18 percent of the ACOs in the survey were taking on two-sided risk, in which they face financial penalties for missing their performance goals. Traditional fee-for-service is still the fiscal engine for most healthcare systems, noted Vengco.

To this end, when asked by a member of the press if the Department of Health and Human Services (HHS) wanting 30 percent of traditional Medicare fee-for-service payments tied to a quality-driven, alternative payment model by the end of this year is too lofty a goal, Premier’s Huizinga said, “those goals are realistic.” She added, “They are aggressive, but doable.”