HITPC: ACO recommendations focus on claims data, better tools, information sharing

The Accountable Care Workgroup’s draft recommendations presented to the Health IT Policy Committee during its July 8 meeting focused on four key areas.

1. Exchanging information across the healthcare community

The data is still very siloed, said workgroup co-chair Grace Terrell. “Major health systems are not widely sharing data either intentionally or because of a lack of capability. We have serious concerns about patient safety and the ability to succeed in accountable care if we don’t take a more integrated approach to information.”

Terrell noted the need for the federal government to present a strong set of expectations for providers, close the investment gap for all providers and integrate with all providers. The workgroup’s recommendations include encouraging the use of admit, discharge, transmit feeds because it’s “a high-impact, relatively low-cost way for organizations to start sharing information.” She also said that as the Office of the National Coordinator for Health IT (ONC) works with the Centers for Medicare & Medicaid Services (CMS) to update hospital survey and certification standards, they could look at more robust levers to encourage data sharing such as reconsidering the conditions for Medicare participation. 

The workgroup also recommended an increase in public transparency around performance on measures related to health information exchange (HIE). “Public transparency could be an important tool for encouraging institutions to share data,” she said.

II. Data portability for accountable care

Accountable care adds two things to data portability, said workgroup co-chair Charles Kennedy—time and financial risk. “Time to deployment of a system that enables interoperable data exchange and more importantly, time to value, the ability to use that data, suddenly becomes incredibly important to these delivery systems. Many expressed frustration with the ability to get vendors to provide that interoperability in a timely fashion,” said Kennedy.

Another issue is the timeliness of the information itself, he said. Rather than retrospective checks, ACOs need more of a navigation system, he said, to anticipate complications and disease progression. However, the tools being used for ACOs are “very much in their infancy.” Kennedy also said that EHRs have a different role in accountable care arrangements, as a “critical data repository for these population health management tools to be able to do population-based assessments.”

The workgroup’s recommendations include a call for publishing APIs—“something in real time that allows the data in EHRs to be made available to other tools required for accountable care. APIs need to focus on making data useful and timely.”

The group also called for a greater level of specificity for interoperability standards because of the importance of maintaining the meaning of the data as it moves from EHRs to population health management tools.

They also recommended strengthening data portability in the technology criteria so users can receive and process data for effective use in patient care. “The ability to leverage data is still quite challenging.”

III. Clinician use of data and information to improve care

Calling the existing health IT immature, Terrell said virtual and interdisciplinary shared care planning is critical to the success of ACOs. “Care planning has been part of care for inpatient settings but not part of our culture.” The workgroup suggested pilot projects to better understand how physicians use electronic shared care planning tools.  “We don’t think at this point there’s adequate real-world experience with care planning models” to begin to mandate anything. They also suggested the convening of a group to accelerate consensus and develop strategies to promote wider adoption of these tools.

The workgroup also recommended working toward increasing sensitivity and specificity in decision support algorithm tools by implementing standards. “A key use case for ACOs around CDS is the ability of external data to be integrated with data in the EHR so they can trigger specific and sensitive algorithmic-driven alerts. More work is needed to get to this level of functionality,” including funding and research.

IV. Leveraging existing sources of information to support data infrastructure for value-based programs

Administrative data hasn’t been the focus for good reason, said Kennedy, including timeliness, accuracy and level of detail. “The richness of a clinical interaction is generally not represented in the claims data stream.”

However, he said claims and administrative datasets can be quite valuable because they help with understanding costs and efficiency. And, when a provider is responsible for a patient population, the provider needs to know if patients are seeking care outside of the system. “Claims data may be the only way you’re able to know if patients are getting care outside your systems.”

There are tremendous challenges in figuring out how to optimally make use of claims data in an ACO setting, he said, but “claims data has a contribution to make in overall ACO operations.” To achieve that, the workgroup recommended that federal agencies work together to articulate a strategy to advance a federated infrastructure to meet the data and analytic needs of providers in ACOs.

They also recommended that federal agencies support the development of an all-payer claims database. Lastly, the group discussed the importance of social determinants of health and called for progress in standardizing and capturing these data elements most critical to ACO models.

The Health IT Policy Committee discussed the recommendations and voted to advance them.