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Reports of savings and lack of savings from the first Accountable Care Organization (ACO) pilots have led payers and policymakers to think about what is needed to reach their financial goals. To that end, the Office of the National Coordinator (ONC) released a report, Health Information Technology to Support Accountable Care Arrangements. It gives a detailed description of the technology needed to successfully implement an ACO. Even though the first ACOs had Electronic Health Records (EHRs) implemented in most of their clinical settings, the capability to facilitate coordination across multiple providers and to utilize the data to create more system efficiencies and improve clinical outcomes has proven elusive. That capability is what Datuit has developed with its technology.

What’s available today. Today’s EHRs generate data that is useful for care, quality measurement and improvement for a provider’s patient population. Since 2009, practices and hospitals have added more technology. It allowed them to become more efficient in creating documentation that supports coding and billing as well as reporting quality metrics to payers. What’s not worked well is information sharing among various providers, patients and caregivers that would facilitate meaningful care coordination. [1]

What more is needed? Effective care coordination is necessary for ACOs to be successful. This means that information about a patient must be available to clinicians across the care continuum. When a patient leaves the hospital, all caregivers and clinicians must be prepared to support the patient’s recovery, and that means sharing more detailed materials than has been available before. In addition, multi-disciplinary teams are necessary to provide comprehensive care, but how can they assure consistent messages to patients and caregivers? The report calls for “electronic shared care plans that allow clinicians and patients to access a common source of information on care goals and interventions…” [2]

Although all ACOs aspire to share clinical information, ACOs have used a variety of approaches to reach this goal. Some have attempted to bring every clinician into the same Electronic Health Record (EHR) environment, but it may not be possible to bring all organizations, including home care agencies, dentists, chiropractors, etc., onto the same system. And in many cases, it is difficult for all clinicians to access the right information at the right time, even if they are in the same environment. HIEs vary in their design and are in their nascent stages in most cases. Some of the first ACOs have included sending alerts for discharges from hospitals and web portals for care coordination across organizations, even those who have not adopted EHRs.

Many ACO patients need long term care services, even if only temporarily. Communication among hospitals, clinicians and long term care providers is improving but still challenging. ACOs need more capabilities to share information among educators, dietitians, social workers, therapists and also with patients and caregivers.

So far, using claims data from health plans has not proven effective in predicting high cost patients and episodes of care. Predictive analytics needs to improve by using clinical and other community data to determine who is at risk before being hospitalized. Organizations will have to develop systems that collect the correct information to manage whole person care in such a way that improves outcomes and reduces healthcare expenditures. [3] Similarly, they will also have to develop ways to report quality measures with data gathered from multiple EHRs – something that right now is very costly and difficult.

Some initial efforts have been piloted to help patients and clinicians more effectively work together to improve care and reduce expensive hospital readmissions. Some Personal Health Record (PHR) pilots and the Blue Button initiative were developed to facilitate the needed patient-provider and provider-provider communication, [4] but there is a long way to go to achieve widespread adoption.

CMS is creating new rules and incentives to make ACOs work for providers and patients, and this includes more incentives for creating and adopting new technologies that facilitate better information sharing and utilization. Datuit has developed the SafeIX collaborative technology that facilitates the requirements in today’s world and in the world of tomorrow. By utilizing a patient-centered approach to data sharing and interoperability, many of the ACOs’ goals can more easily be achieved. We welcome partners that also want to see the promises of ACOs fulfilled.

[1] A recent report on Health Information Exchanges (HIEs) finds that there is little evidence that they are being widely used by providers, and that even if they were to be more widely used that they would reduce healthcare costs. In addition, only approximately 25% of HIEs report that they are financially stable. Robert S. Rubin, et al. Usage and Effect of Health Information Exchange: A Systematic Review. Ann Intern Med 161(11): 803-11 (2014). Accessed at http://annals.org/article.aspx?articleid=1983413 (subscription required).

[2] ONC, Health Information Technology Infrastructure to Support Accountable Care Arrangements (October 2014), page 11. Accessed at http://healthit.gov/sites/default/files/Report-HITtoSupportAccountableCareArrangements.pdf.

[3] ONC, Health Information Technology Infrastructure to Support Accountable Care Arrangements (October 2014), page 16. Accessed at http://healthit.gov/sites/default/files/Report-HITtoSupportAccountableCareArrangements.pdf.

[4] ONC, Health Information Technology Infrastructure to Support Accountable Care Arrangements (October 2014), page 18. Accessed at http://healthit.gov/sites/default/files/Report-HITtoSupportAccountableCareArrangements.pdf.