A recent study by the HHS Office of Inspector General suggests that Medicare ACOs coordinate care more effectively when they have the right health IT tools in place, particularly when ACO members share one EHR platform and have access to a robust HIE.
Folks, I know that reading OIG reports can be about as exciting as watching cement harden, but bear with me — some of this stuff is interesting.
As the OIG report notes, CMS sees care coordination as essential to improving care, boosting patient health and lowering costs. And as we all know here, one way to improve such coordination is to make it easy for providers to share patient health information.
The question is whether they’ll have the resources to do this well. CMS and the ONC already released a broader draft strategy paper spelling out its approach to reducing the HIT-related burdens on frontline healthcare providers. Its three goals include reducing the time and effort clinicians need to spend entering enter data into EHRs, minimizing the time and effort providers spend meeting regulatory reporting requirements and improving how EHRs function. But there’s no question that they’re particularly interested in care coordination options.
To determine whether health IT tools are supporting this function effectively in Medicare ACOs, the OIG picked out six of them which met some key criteria, including their performance standards on a quality measure related to patient safety and care coordination. They also confined their research to entities which had a minimum of three years of experience serving as a Medicare ACO. The number of Medicare enrollees per entity ranged from a modest 7,000 to more than 72,000, with two participants in the Medicare Shared Savings Program and four operating as Next Generation ACOs.
When the OIG took a look at this select group, they concluded that overall, health IT tools had definitely allowed the ACOs to improve how they coordinated patient care.
In most cases, the OIG found, the ACOs used data analytics support the care coordination efforts, specifically by identifying a group of patients with costly health conditions. That being said, few were using analytics to customize care for individual patients, which is arguably a significant missed opportunity.
The most successful ACOs were those that used a single EHR across their provider network and shared patient data in real time, an arrangement which also allowed providers to leverage tools like shared patient care checklists. A small number of more fortunate ACOs within the group also had access to flourishing HIEs which offered providers access to patient data even if they were seen outside the ACO network.
Others they studied, however, were using multiple EHR systems with little or no capacity to share data back and forth. Providers in these ACOs were still having to transmit patient data in more labor-intensive ways such as faxing or emailing records. Also, in some cases, clinicians who didn’t work for the ACO were only given read-only access to patient data, which might make sense from a security standpoint but isn’t great for coordinating care.
Meanwhile, the researchers found that when physicians had to manage data across multiple EHRs, it had a tendency to worsen physician burnout. Not only that, in most cases the HIEs the used offered little or incomplete data. As a result, providers in these settings had difficulty coordinating care when patients went to providers outside of the ACO network.
As a longtime health IT observer, it’s frustrating to read that the challenges ACOs are facing have changed so little since they were first invented. (Ideally, they’d at least be struggling with newer, more interesting technologies with great potential, such as machine learning.) As is usually the case with HIT adoption, a small, sophisticated group of Medicare ACOs seem to be developing mature analytics infrastructures while others are stuck in the mushy middle.
This can’t be good. As I noted previously, Medicare ACOs might not survive CMS’ plans to impose new financial risks on participating organizations if their IT infrastructure isn’t good enough.
Still, it’s nice to see that at least the leading-edge Medicare ACOs have gotten their arms around some key analytics functions. It may be progress just for a few, but I’ll take it.