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How 3 ACOs Use Technology To Survive

Nine accountable care organizations are dropping out of a program touted as a key cost-saving element of Obamacare. Here's how three providers are using technology to stick it out.

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Information technology is indispensable to the success of an accountable care organization. You can't have coordinated healthcare without the IT to back it up, and with nine of 32 pilot ACOs dropping out of the program, industry leaders are assessing what it takes to do ACOs right and what lessons they've learned so far.

The Centers for Medicare and Medicaid Services said Tuesday that nine of the 32 pioneer ACOs were dropping out, and two of the ACOs shared losses totaling approximately $4 million. ACOs are one of the big ideas of U.S. healthcare reform -- that by paying providers to keep people healthy, rather than for the number of procedures they do, care will improve and costs will fall.

At this critical juncture of the ACO program, we spoke with technology leaders at three pioneer ACOs that plan to stay in the program. These leaders highlighted three key areas where information technology provides a foundation for successful ACO operation.

Information Exchange

At the core of information exchange is the adoption of an electronic health record system. If implemented to allow data sharing, EHRs allow multiple doctors to manage patient care from exam room to hospital bed to the patient's home.

Atrius Health uses Epic's EHR system at multiple levels. In the exam room, the system is used to document the patient visit, order medication or laboratory work, and check if preventative care is up-to-date. The system also provides "decision support" information that helps physicians manage care to make it well-coordinated and less costly, said Richard Lopez, the chief medical officer at Atrius Health. Decision support can give physicians the option of generic medication over brand medication, and will display the costs of certain labs.

"We do this not so much to impact what the clinician is going to do, but to sensitize clinicians to the cost of services provided," Lopez said.

Atrius also uses Epic to facilitate communication between primary care physicians and specialists as well between Atrius's preferred hospitals.

Patient engagement, an increasingly hot topic in healthcare IT, plays a role in ACO information exchange as well. Patient engagement is about improving care but it's also a smart business move, said Bill Spooner, CIO at Sharp Healthcare.

"We want our patients to be sticky," he said.

In other words, Spooner wants patients to come back to Sharp for their care. Sharp does this by creating a substantial online presence and patient portal. Atrius and Beth Israel Deaconess Medical Center in Boston also have patient portals where patients can view upcoming appointments and test results, among other personal information.

Information exchange has boundaries, at the policy level and the technical level. The diversity of privacy laws in the U.S. makes the creation of a uniform national EHR system challenging, said John Halamka, CIO at BIDMC. Interoperability of different vendors' EHR systems is also a challenge, as "there aren't uniform standards for these systems to talk to each other," Lopez said.

Adoption of new technologies is also challenging. Just because an ACO has adopted an EHR system doesn't mean it's being used effectively, Spooner said.

"There is clearly some loss of productivity in the early days of learning EHR, and the question is how to get through that as quickly as possible," he said.

Atrius's Lopez said there are varying degrees of clinician competence with these new systems.

"Some physicians feel it slows them down, and that it's a little clumsy," he said. "There's a continuous effort to get clinicians to be proficient with the technology so that using this fantastic tool doesn't slow them down."

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User Rank: Apprentice
8/1/2013 | 3:08:48 AM
re: How 3 ACOs Use Technology To Survive
I think that you hit on every point needed for ACOs to be successful here. It isnG«÷t an easy undertaking and encompasses much more than most organizations think. From successful implementation of EHRs, to patient involvement, and data analytics, successful ACOs need to be able to adapt and use technology to their benefits. As you say, the provider is the one that is accountable here, so they have to use all methods available to keep the patients happy and healthy.

Jay Simmons
Information Week Contributor
User Rank: Apprentice
7/25/2013 | 10:32:41 PM
re: How 3 ACOs Use Technology To Survive
I just read, with interest, your article in Information Week about how three ACO's are using technology to survive. It is a good article, however I want to make a few comments. I am re-entering the field of medicine after a 12-year absence from clinical practice. Back in 2001, hospitals were just beginning to talk about EMR. I had a little experience with the VA system in Northern California. I am hopeful that data can be used in ways to increase my productivity as well as promote conditions that generally enhance patient safety and general well-being.

During the past 5 years I went back to graduate school and earned an MBA in General Business Administration. I learned there that in general, IT projects have failed to deliver expected gains in productivity approximately 65% of the time, across all industries. Why should we think that healthcare industry would be any different?

I have talked to some of my former colleagues who are now working with EMR, usually because it has been imposed upon them by the hospital system with which they are under. They tell me that productivity has gone down. Before EMR they could easily see 25 patients a day in our specialty. Now they can barely see 16 patients a day. This is a considerable drop, and they are into EMR two years or longer now. Isn't there data available on this drop? I would really like to know what kinds of date the hospital systems are collecting regarding adoption and how they are using this data to improve adoption and productivity. If productivity suffers permanently, how can we say that EMR is good for overall healthcare, given the current doctor shortage? In another way of speaking, isn't being seen by a doctor when you need one more important to overall healthcare than EMR adoption?

Another thing that concerns me is the data being gathered and how it is looked at. Sure, it's easy to design EMR with alerts for needed vaccinations and medication renewals, but I thought there was a movement within healthcare IT to design program functionality around the needs of doctors and other team members delivering care, instead of programming for needs that are defined by IT professionals with no healthcare experience or training.

For example, a doctor doesn't need an EMR program to alert him to the fact that a 94 year-old male with chronic renal failure and hypertension needs to be on the High Risk Medicare Roster. Furthermore, unless someone is constantly performing home visits and reminding the patient weekly to cut down on salt and take his medication, and watch his diet, he will invariably require hospitalization again when his condition deteriorates. This is the dilemma of ACO's. There is very little they can do to keep some patients "healthy" as defined by lessening their need of additional outpatient or inpatient services. The effort needs to be put into prevention at a much earlier stage in people's lives, before they ever get to the ACO. The way I see it, ACO's are merely gambling with numbers of various patient groups, and the more sick their demographic is, the less likely they are going to save the system any money, and less likely to remain profitable themselves. The only way they can remain viable is to not admit patients to their organization with high utilization needs, so risk reduction for the ACO becomes necessarily focused upon patient selection. In science, we would call this "selection bias" if we were doing a scientific study.

What are we going to measure? How are we going to measure it? How are we going to use the data to improve conditions for providers and patients? These are the questions IT needs to be asking.

And for organizations currently working with EMR implementation and adoption, they need to be tracking data that will be meaningful to themselves and others who are not as far along the in the EMR adoption process. What can we learn from non-biased data gathering, from different hospital systems and HCO's who have adopted EMR? How long does productivity at the physician office level actually suffer? How has this impacted the system financially? How has it impacted patient wait times to get an appointment, or their hospitalization rates? (for chronically ill patients). These are the questions I find myself wanting answers to.

Anyway, thank you for writing a provocative article. Perhaps CMS has data on some of my questions, or there is some book or online source of information you can point me to to answer some of them. And perhaps I have given you some ideas for future articles that you can write, too. Thank you for making me think about it.
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