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Growth of ACO model stunted by slow technology adoption

Lagging HIE participation and financial concerns are two major issues that have frozen the development of the pay-for-performance ACO model.

While more than 300 accountable care organizations exist since the Affordable Care Act launched the innovative fee-for-health payment model, there are significant hurdles blocking their continued success and expansion, according to a recent eHealth Initiative webinar.

ACO models offer a unique approach to solving some of the complex healthcare issues in the U.S. Their focus on improving patient outcomes while shifting the payment model into a pay-for-performance instead of a fee-for-service system holds the promise of a better healthcare system. Healthcare professionals participating in an ACO know its foundation must be built on collaboration.

Member providers from different disciplines should be allowed to work together when taking care of patients. This would allow the formation of ACO-wide care teams. Each could oversee the health of a subset of a population of patients with similar conditions, such as diabetes or congestive heart failure.

In order to accomplish this collaborative goal, many technology requirements must be met. Unfortunately, many ACOs continue to be plagued with significant IT and workflow challenges that present a serious threat to their sustainability and mission.

Health information exchange

Lack of widespread HIE adoption is a barrier to open data sharing for ACOs. The inability to gain access to patient health records shared between providers using different EHR systems that hold the health record poses a significant problem for ACO participants. It gives providers limited visibility of patients' current health information, making it difficult for them to know how to treat them.

Patient engagement tools

ACOs aim to get patients more involved in their own care. Encouraging patient engagement creates greater accountability and could motivate patients to significantly improve their health. Most patient engagement tools involve modern technology and haven't been tested enough for providers to trust in their efficacy. For that reason, many ACOs choose a more traditional route and rely on telephone and in-person communication to ensure patients stay in touch and follow up with any questions they might have.

Health IT costs

In the webinar, the eHealth Initiative shared the results of a survey co-performed with Premier Inc. One statistic conveyed that "cost and return on investment are crippling concerns" for ACO participation, with 14% of respondents showing concerns in these areas in 2013, a percentage that rose to more than 90% of ACOs in 2014.

Employee training, technology platforms and services have shown little change in pricing despite an increase in ACO technology vendors. Lack of adoption of state or federal HIEs forced many ACOs to seek private HIE formations. This forces members to chip in and fund system upgrades to meet the data exchange requirements. These upgrades come at a price and have yet to see a significant ROI.


The meaningful use program and EHR certification requirements support the goal of interoperability. Unfortunately, many ACOs are coping with significant gaps in this area. Typically, several large systems within ACO IT environments are unable to interface and exchange health information with each other.

Data analytics challenges

Data analytics holds many of the insights needed to quantify how the ACO model serves healthcare. This can only be possible if the analytics platform can gain access to comprehensive population health information. Many ACOs are limited to what information may be accessible to them. Claims information and clinical data seem to be the only data sets that are easily accessible, leaving registry information, patient's reported data, remote monitoring and other sensory data inaccessible and isolated.

ACOs have the blueprint to make a significant impact on healthcare, but most of them are in the process of dealing with complex health IT challenges. This has left ACO leadership looking for effective strategies to execute their business plans. Technology is one thing that will continue to serve a key role in helping ACOs accomplish their objectives. As more ACOs begin to form and grow, they will have to lean on each other by sharing lessons and best practices to help ensure the sustainability of the ACO model.

About the author:
Reda Chouffani is vice president of development with Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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