Accountable Care Organizations Struggle With Health IT Infrastructure

Accountable care organizations (ACOs) are taking a variety of approaches to building health IT infrastructures, according to a forthcoming report from Leavitt Partners, a research firm in Salt Lake City, and KLAS Research, which is based in Orem, Utah. But it's clear that healthcare organizations with integrated clinical and financial systems have an early lead in the race to assemble these new healthcare reform models.

Leavitt Partners, which has previously released two reports on ACOs, held a webinar recently to outline the report's key findings. Among other things, the researchers identified 320 ACOs, up from 220 in a June 2012 report. In the latest findings, 158 ACOs were sponsored by hospital systems; 133 by physician groups and individual practice associations; 30 by health plans; and eight by community-based organizations.

Leavitt Partners surveyed all 320 ACOs, and KLAS conducted interviews with leaders of 60 organizations. From this information, they constructed a view of ACOs' health IT infrastructure that they shared with InformationWeek Healthcare.

ACO leaders agreed that they need clinical information systems that can enable them to do population health management (PHM) -- a systematic approach to keeping patients healthy and ameliorating the effects of chronic diseases. But the applications they were investing in varied from general-purpose business intelligence software from IBM or Oracle to more targeted applications from companies like Medventive, Wellcentive and Phytel, said Colin Buckley, strategic operations director for KLAS, in an interview with InformationWeek Healthcare.

[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS's top-ranked systems, see 10 Top Medical Practice Management Software Systems. ]

The population health management (PHM) software market is wide open, with a bewildering diversity of products, he added. "There is no one or two vendors that own this space, and the functionality and the offerings are very fragmented."

To coordinate patient care effectively -- a key part of PHM -- 77% of the ACO survey respondents said it was important to deploy care managers. Sixty percent said patient-centered medical homes were essential and 60% viewed the use of electronic patient registries as a key part of their care coordination strategy.

Buckley cautioned that the definition of registries differs from one ACO to another. Some view them as a part of their electronic health record systems, which may be able to generate lists of patient subgroups, such as diabetics and information about their health status. Other ACOs use third-party software that has the ability to generate reports and alerts from registries. And some large organizations have designed their own registries for use with their sophisticated data warehouses.

More than three quarters of the respondents said that clinical systems integration was critical or important. Buckley said that most of these ACOs were referring to the integration of inpatient and outpatient information within an enterprise, rather than across multiple provider entities.

"Many of them thought it was important to move to a vendor like Epic or Cerner that has all of the pieces connected and stores information in a single database, versus having one vendor for the hospital, several in the ambulatory sites and other best-of-breed products that they would have to tie together," according to Buckley.

Physician-led ACOs, which are growing faster than those led by hospitals, tend to have a somewhat different view because they consist of multiple entities that frequently have disparate EHRs, Buckley noted. The most efficient way to integrate these systems is by using a health information exchange (HIE). Some of these physician-led ACOs were interested in acquiring their own HIEs because they didn't see much point in connecting with hospitals, he said.

"Not all of them feel they need to tie the hospital in, because their goal is to keep people from going to the hospital in the first place."

Other physician-sponsored ACOs might use community HIEs where they exist. But there are a few problems with that, Buckley pointed out. First, public HIEs are growing much more slowly than private exchanges purchased by hospital systems. Second, it's very expensive and time-consuming to connect with HIEs, and most of them are not very good at moving information yet, he said.

Access to fragmentary data on some patients is not good enough for ACOs, he said. "They need the data ahead of time and they need it to be comprehensive and as up to date as possible. It's just not working that way for the majority of organizations that don't have an integrated system like a Cerner or an Epic."