By Jeffrey H. Brochin, J.D.
The full potential of health IT has not been realized as accountable care organizations vary in the extent to which they can rely on these tools.
An HHS Office of Inspector General (OIG) review of how Medicare accountable care organizations (ACOs) have used health IT tools to better coordinate care for their patients, has concluded that although health IT has significantly enhanced providers’ opportunities to coordinate patient care across healthcare settings, the ACOs still face challenges in these areas, resulting in the ACOs having to rely on other means to share data among providers by either using additional health IT tools or relying on phone calls and faxes. Although electronic health records (EHRs) are intended to streamline, coordinate, and improve care, ACOs reported that EHRs can also be burdensome and frustrating for providers. (OIG Report, OEI 01-16-00180, May 17, 2019).
The role of ACOs. Medicare patients often have chronic medical conditions that require care from multiple providers, and statistically, more than half of Americans older than 65 require significant medical or functional support. This care comes at a considerable cost to the program, and as a result, alternative payment approaches to healthcare have emerged in which providers have financial incentives to identify risky patients and coordinate their care before those patients’ complex needs result in even higher costs. ACOs are one type of alternative approach. An ACO is a network of doctors, hospitals, or other healthcare providers that come together voluntarily to coordinate high-quality care for their patients and be accountable for the total cost and quality of the care provided.
Why OIG conducted the study. The purpose of the study was to provide insights into how select ACOs have used health IT tools to better coordinate care for their patients, and to help ACOs anticipate challenges they might face and help CMS and the Office of the National Coordinator for Health IT (ONC) assist ACOs in overcoming those challenges. Medicare patients often have chronic medical conditions that require care from multiple providers, and care coordination helps ensure that patients’ needs for health services are met over time and across multiple encounters and settings. CMS has identified care coordination as integral to achieving better care, improved health, and lower costs.
How OIG conducted the review. The OIG based the data brief on interviews conducted during site visits to six Medicare ACOs. The OIG considered the following factors when selecting ACOs: their performance on a quality measure focused on care coordination and patient safety, a minimum of 3 years of experience as a Medicare ACO, geographic variation, and recommendations from CMS and ONC. Each site visit consisted of interviews with ACO administrative and technical staff as well as separate interviews with clinical staff. The site visits took place during April and May 2018.
What the study found. Among the findings of the study was that health IT tools have enabled the six Medicare ACOs visited to better coordinate patient care. ACOs that used a single EHR system across their provider networks were able to share data in real time, enhancing providers’ ability to coordinate care, and a small number of ACOs had access to robust health information exchanges. Most of the ACOs used data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions.
However, ACOs still face challenges: ACOs that used multiple EHR systems had to rely on other means to share data among providers, either using additional health IT tools or relying on phone calls and faxes. Although EHRs were intended to streamline, coordinate, and improve care, ACOs reported that EHRs were at the same time burdensome and frustrating for providers. ACOs also faced challenges from physician burnout due to the workload of managing EHRs. Most of the ACOs had access to health information exchanges with little or incomplete data, making it difficult to coordinate care when patients saw providers outside the ACOs’ networks. Few of the ACOs used analytics to customize care to an individual patient’s needs. Finally, few ACOs offered health IT tools to patients, other than online portals to EHRs.
Conclusions. The study determined that although the six ACOs visited have used health IT tools to better coordinate care for their patients, the promise of seamless integration and coordination across providers and care settings has not yet been realized. ACOs vary in the extent to which they can rely on health IT tools, in some cases because those tools cannot reach all providers involved in a patient’s care, or because the tools lack the necessary information that ACOs need. Achieving the interoperability needed for seamless care coordination places burdens on ACOs to either invest in a single EHR system or use other methods, such as non-health IT means, to communicate health information.
MainStory: TopStory ACONews CMSNews EHRNews HITNews QualityNews
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