HITPC: Major health IT challenges hamper ACOs

Many accountable care organizations (ACOs) are frustrated with the inability to integrate data across platforms and systems, reported the ACO Workgroup at the Health IT Policy Committee meeting on Jan. 14.

The workgroup had convened a hearing of ACO stakeholders—including physicians, health system leaders and vendors—as part of its work to present recommendations in March on how Department of Health and Human Services policies and programs can advance the evolution of health IT infrastructure. In particular, the workgroup is examining how health IT can enable providers to improve care and population health while reducing costs under accountable care arrangements.

Workgroup Chairman Charles Kennedy, ‎CEO of accountable care solutions at Aetna and Co-chair Grace Terrell, MD, president and CEO of Cornerstone Healthcare, described an at-times emotional hearing where participants expressed frustration with persisting health IT problems, in particular data exchange and provider disincentive to share data with others outside of their system.

Kennedy and Terrell reported the following take-aways from the hearing:

• Data integration across EHR systems and with population health platforms remains a challenge for providers. The “loudest message we heard was that cross-vendor integration was a problem with large systems interested in taking risk. They were unable to get vendors to collaborate and exchange information,” Kennedy said.
• Technical, strategic and financial considerations inhibit providers from exchanging information to support care coordination. “There are negative care incentives to exchange information across systems.”
• While providers in accountable care arrangements are acutely experiencing these challenges today, they do not have the leverage to drive solutions alone.
• HIEs are facilitating exchange for accountable care in select markets, but sustainability and geographical spread remain major concerns.
• There is lack of clarity and consensus around the key quality measures needed to effectively drive care improvement.
• While some providers use Meaningful Use requirements as a foundation for care transformation, many are still focused on simple reporting compliance. “Some panelists told a positive story around leveraging Meaningful Use for success in ACOs. Another group hadn’t found ways to successfully integrate requirements of Meaningful Use and quality reporting,” Terrell said.
• ACOs need to do more to prioritize a patient‐centered approach. Terrell noted that the “explosion of patient portals” is creating confusion for patients.
• Smaller organizations are facing challenges in meeting the IT investments and administrative burden associated with accountable care payment models.
• Providers under accountable care arrangements face barriers to obtaining critical information around behavioral health and other sensitive information to inform care.

“We walked away with the impression that there is a significant gap between the technology and functionality available and Meaningful Use requirements, as well as the ability to use that within the accountable care construct. As we move forward, these perspectives will shape our work as we prepare recommendations for the committee,” said Kennedy.