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Interoperability continues to challenge ACOs


Concerns about cost and ROI are widespread

Interoperability of disparate systems is a significant challenge for 95% of accountable care organizations (ACOs), and the cost and return-on-investment of health information technology (HIT) has become a crippling concern and key barrier to further implementations, according to a new survey.

And as ACOs pull data from more sources, they also report lower abilities to leverage their HIT infrastructure to support care coordination, patient engagement, population health management and quality measurement.

The survey, conducted by Premier, Inc. and the eHealth Initiative, collected responses from 62 ACOs including members of Premier's PACT Population Health Collaborative.

Eighty-eight percent of ACOs reported facing significant obstacles in integrating data from disparate sources, and 83% reported challenges integrating technology analytics into workflow. Both become more acute when adding new platforms or building on a network of medical settings.

READ: HIT and medication adherence: Aligning incentives

ACOs are largely comprised of primary care clinics and practices (90%), specialists (84%), acute care hospitals (57%) and health systems (53%). Surveyed ACOs primarily serve between 10,000 to 100,000 patients, the majority of which are on Medicare, and are primarily funded and administered by a health system (33%), medical group (16%) or independent practice association (12%). 

As ACOs collect data from more sources, they also report more concerns about interoperability and data management.

“Poor interoperability across systems and access to data is challenging for organizations attempting to do this,” says Jennifer Covich Bordenick, chief executive officer of eHealth Initiative. “The fact that 100% of the respondents found interoperability a significant challenge is telling. Everyone is struggling with this.  

“I think this is wake up call for all healthcare decision makers,” she adds. “Executives need to carefully weigh their technology investment decisions, as it will directly impact their ability to deliver care and manage costs.”  

Organizations need policies and technology in place that allow them to access and share data with groups outside of their organization, Bordenick says.

“Patients don’t live and breathe within a single network. If you want to successfully manage a patient’s care, you need to go beyond the ‘walls’ of your network,” she says. “ACOs will need to find ways to work with competitors and groups they may not do business with right now and figure out cost-effective ways to connect.”

The survey, which was fielded in July to August 2014, found that ACO patients can generally use basic Internet-based tools, but mobile and consumer trends are not yet widespread.

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At least half to two-thirds of ACOs reported improvements in clinical quality (66%), preventive screenings and vaccinations (63%), chronic disease management (59%) and health outcomes (55%).

The majority of survey participants report having an HIT infrastructure that can support quality measurement, population health management, physician payment and contract adjudication.

Other findings:

  • The majority of respondents had been operating for at least 18 months;

  • Thirty-five percent were in mature stages of operation (more than two years), 20% were in advanced stages of operation (between 18 and 24 months) and 20% were in intermediate stages of operation (12 to 18 months); and 

  • Nearly all responding ACOs were of a medium to large size with between 101 to 500 physicians (39%) or more than 500 (41%) physicians.
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