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By Alex Ruoff
Aug. 12 — The majority of accountable care organizations (ACOs) have not progressed from simply collecting health data electronically to using electronic data for analysis and care coordination, according to preliminary results of a survey released Aug. 12 by the eHealth Initiative and the research group Premier Inc.
Although ACOs are maturing—the Medicare Shared Savings Program added 229 ACOs between 2012 and 2013 and the majority of ACOs surveyed were more than a year old—they continue to rely on basic health information technology infrastructure, such as electronic health records with few advanced capabilities such as population health management or cost-analysis tools.
Despite expectations from federal regulators and health executives that ACOs would be industry leaders in the use of health IT, few ACOs are using telehealth technologies and remote patient monitoring tools or participating in electronic health information exchange with other health-care organizations and public health registries.
“ACOs are seeing growing pains when it comes to their health IT infrastructure,” Jon Dimsdale, director of programs and research at the eHealth Initiative, said during an Aug. 12 webinar. “Most were able to put in some key health IT building blocks, but they now face barriers [doing more].”
While the use of health IT by providers is believed to lower costs and improve quality, analytics tools can be costly and disruptive for clinicians, executives from two ACOs said during a presentation of the survey findings. Both executives advised ACOs to invest in technology and train clinicians in their use.
Stephen Nuckolls, chief executive officer of the Coastal Carolina Quality Care ACO, a multi-speciality group practice located in New Bern, N.C., said his organization used early funds from insurers to provide funding to clinicians for systemwide adoption of EHRs, all of which are connected to a patient portal that offers patients online access to their health records. He said his organization hired medical scribes to help providers offset possible drops in efficiency and see more patients each day while maintaining up-to-date electronic records.
“Our ACO was fortunate we were an advanced payment model, which means we received an advanced payment for future savings to make an investment in our infrastructure,” Nuckolls said. “So cost was not as big a factor for us as it might have been.”
Still, he said, some clinicians were resistant to adopting EHRs and working with IT personnel at Coastal Carolina Quality Care ACO.
Clinician training with health IT tools is essential to expanding the use of technologies in an ACO, Andrew Weniger, product strategy officer for Cornerstone Health Care in High Point, N.C., which entered into a long-term value-based contract with Blue Cross Blue Shield of North Carolina in 2013, said. He said ACOs need physician leaders who can champion the use of health IT among clinicians.
“We leveraged our EMRs [electronic medical records] as a big foundation for our activities,” Weniger said. “We pulled quality measurement data from our EMRs and were transparent with the results, comparing physician data to let them know where they stand. There was a lot of hand-holding and coaching that went into that, though, and we were assisted by our physician leaders.”
The vast majority—95 percent—of ACOs surveyed by Premier reported they were collecting clinical data using their EHRs and receiving post-adjudicated claims data from local insurers. Sixty-three percent of ACOs surveyed reported collecting pre-adjudicated administrative, billing and financial data on patients from insurers.
Less than 40 percent of ACOs are collecting data from public health registries or directly from patients, the survey said. Less than a quarter of ACOs surveyed said they collect data from remote monitoring devices and sensors or from local or state health information exchange organizations.
Less than a third of ACOs surveyed said they had deployed health IT services to increase patient access to care, such as self-serve scheduling or telehealth tools.
ACOs cited technology costs, a lack of interoperability between EHR systems, a lack of provider engagement and privacy and confidentiality concerns as barriers to adopting health IT tools.
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