The accountable care organization model of care has caught the eye of many hospitals and physician practices, and payers are likely to start reimbursing with more ACO-type reporting requirements in 2013, IT professionals said. But some may find that the technology necessary to support this transition is not yet in place.
Suddenly your financial survival is not based on just getting paid for what you do. It's your ability to manage cost and quality, and that's an enormous change.
Dan Moriarty, chief information officer at Atrius Health
The Patient Protection and Affordable Care Act initiated an incentive program through Medicare that rewards practices that begin operating as accountable care organizations (ACOs). Many private payers have followed this example, launching their own initiatives to drive providers toward becoming ACOs. This has produced a swell of interest in the model.
But there are some things providers should know before jumping into the ACO pool. There are major technical barriers that must be crossed before taking on more financial risk for patients' health. Sometimes, there are no easy solutions for these problems.
For example, the ACO model relies heavily on information exchange. Members of the medical team must have access to patient health records, even if the patient seeks care outside an ACO's network. But Jennifer Jackson, senior director of business intelligence and ACO information technology at Banner Health, said some states may not have a sufficient health information exchange (HIE) infrastructure in place to satisfy the needs of ACOs.
HIEs may be public or private. The federal government made nearly $550 million available to state agencies in 2010 to support the development of state-wide HIEs. Additionally, private organizations are working to develop their own infrastructure. But Jackson said these initiatives have not created the kind of capacity needed to support ACOs.
"I think you're going to see a lot of focused energy on tying in the HIE and making it more robust," Jackson said. She added that some states are farther ahead in standing up their HIE infrastructure, so practices around the country may have different experiences.
Another challenge for providers moving to the ACO model may be setting up data analytics initiatives. Dan Moriarty, chief information officer at Atrius Health, said deep analytic capability is one of the most important features of successful ACOs, but it demands significant technical know-how. Providers that are just starting to move toward accountable care in 2013 may not have teams in place to take on this IT challenge.
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Analytics plays a key role in nearly everything an ACO does, Moriarty said. It is involved in disease management, population health and quality reporting, all of which are important to keeping patients healthy and helping organizations maximize their payments. But setting up analytics systems involves integrating data from health records, medical claims and other organizations' databases. Setting up this kind of system will be a big shift for most providers.
"Suddenly your financial survival is not based on just getting paid for what you do," Moriarty said. "It's your ability to manage cost and quality, and that's an enormous change. If you don't have [analytics] as an ACO you're flying blind. You could not survive without analytics."
Other points to consider:
- Don’t outsource your analytics: The number of third-party analytics companies in the market is increasing rapidly, but Moriarty said this is the kind of thing an ACO needs to be able to do itself.
- There is an opportunity in electronic data capture: Some ACOs are still collecting data for quality reporting manually, transferring it from non-networked sources. Jackson said networking all data sources and automating reporting could improve efficiency.
- Get a population health management system: Banner Health partnered with an outside vendor to analyze its population-wide data and identify appropriate interventions for those who need it most.
- Interoperability is key: Care coordination is one of the hallmarks of successful ACOs. In order to coordinate services among multiple offices that may use disparate IT systems, ACOs will have to develop a plan for solving interoperability problems.
Both Moriarty and Jackson said they expect more patients to start receiving care from ACOs in 2013, as providers will find a greater number of incentives for operating under the model. However, even as payment systems make accountable care more attractive, providers may still find significant technical challenges. Overcoming these obstacles will be key to the success of new ACOs in 2013.