Leveraging Health Information Technology for ACO Success

The American Journal of Accountable Care. 2020;8(1):6-7. https://doi.org/10.37765/ajac.2020.88354

In September 2019, CMS released performance results for the sixth year of Medicare’s flagship accountable care organization (ACO) program, the Medicare Shared Savings Program (MSSP). Detailed in a Health Affairs blog post,¹ the 2018 data show progress on the path to value-based care. Specifically, they show modest but steady increases in cost savings over time, as well as quantifiable improvements in care quality and outcomes relative to the benchmarks set by CMS.

Of the 548 ACOs that participated in MSSP, 205 of them earned savings. Although less than half may not sound especially impressive, it is important to consider how much change is required of providers in a relatively short amount of time to succeed. In addition to executive commitment and physician buy-in, significant investments in technology infrastructure are necessary. However, as many ACOs have demonstrated, when the proper tools are in place, improvements in care delivery and cost savings are achievable.

Implementing the Needed Infrastructure

At its core, the ACO model requires care providers to move away from traditional siloed care toward more team-based, coordinated care to attain desired outcomes. Health information technology (IT) is a critical enabler of this transition, supporting more efficient data collection, analysis, and exchange.

Examples include the following:

• Sharing information among clinicians, patients, and other stakeholders across care settings
• Integrating clinical, financial, and operational data from various sources
• Managing the health of patient populations
• Maintaining the privacy and security of protected health information
• Streamlining the reporting of quality metrics required by CMS

Addressing Access Challenges

Even with the best technology in place, however, ACOs may still face the challenge of data access. Because data aggregation and analysis are required to efficiently identify gaps in care, deliver actionable insights to clinicians in a timely manner, and track progress against program benchmarks, long wait times for data from vendors and CMS can easily impede optimal performance.

Indeed, this was the experience of an ACO located in the Southwest. The ACO worked with many vendors that were slow to provide clinicians with the data that they needed to inform treatment, and it struggled with the 3-month wait times for claims data from CMS.

The ACO recognized early on that it needed ready access to data to be successful. It was then that the organization turned to a solutions provider offering a combination of electronic health record (EHR), revenue cycle management, and practice management tools, as well as an enhanced results data set, to supplement claims information, enhance diagnostic precision, provide actionable insights at the point of care, and ultimately help achieve its performance goals. The critical success factor was the integrated nature of the tools, which prevented disruption to the clinicians’ workflow.

Acting on Insights

By integrating multiple data sources, such technology provides the ACO clinicians with a more holistic view of individual patients, as well as overall patient populations, for better management. It also enables the creation of comprehensive patient profiles to help identify which patients are at highest risk.

Moreover, with the technology in place, clinicians can easily identify where quality gaps exist. For example, while the clinician is in the room with a patient for a visit, they are alerted via EHR to needed actions. This point-of-care tool helps the clinician address care gaps on the spot—saving valuable time, improving the quality of care delivered, and enhancing the overall patient experience.

Technology suites can also enable efficient capture of quality metrics and accurate tracking of performance in MSSP.

Looking Ahead

The critical role that IT plays in overcoming the challenges faced by ACOs is clear. Elements such as EHR integration, point-of-care solutions that work within existing workflows, and other care coordination solutions make a real difference. Technology that is capable of painting a better picture of a patient’s health helps clinicians keep patients out of the hospital—the goal of every care provider in the country. Obtaining the necessary information in nearly real time and getting a lead on a patient’s upcoming acuity is the secret sauce in the ACO business.

The healthcare industry’s transition to value is breeding innovation at a rapid pace. ACOs and other forward-looking provider organizations are demonstrating that with the right resources and technological initiatives, it is possible to increase patient engagement and offer improved experiences for all involved in healthcare delivery. In effect, the work of these ACOs is paving the way to achieving the Quadruple Aim: improving patients’ health, improving patients’ experiences with the healthcare system, reducing the cost of care, and improving the experiences of healthcare providers themselves.

Author Affiliation: Quest Diagnostics, Secaucus, NJ.

Source of Funding: None.

Author Disclosures: The author reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Critical revision of the manuscript for important intellectual content; obtaining funding; and supervision.

Send Correspondence to: Tom Romeo, Healthcare IT and Quanum Solutions, Quest Diagnostics, 500 Plaza Dr, Secaucus, NJ 07094. Email: Tom.J.Romeo@questdiagnostics.com.

REFERENCE

1. Gonzalez-Smith J, Bleser WK, Muhlestein D, Richards R, McClellan MB, Saunders RS. Medicare ACO results for 2018: more downside risk adoption, more savings, and all ACO types now averaging savings. Health Affairs website. healthaffairs.org/do/10.1377/hblog20191024.65681/full. Published October 25, 2019. Accessed December 19, 2019.

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