Accountable care organizations (ACO) are designed to be both a representation of the shift toward value-based healthcare, as well as a blueprint for how to accomplish it. However, data from the Premier Research Institute, among other organizations, paints a different picture.
The study, "Performance Evaluation: What is Working in Accountable Care Organizations?", found numerous challenges faced by ACOs, among them insufficient funding, data system interoperability and physicians failing to move on from a fee-for-service approach to healthcare.
These obstacles depict a troubling trend for ACOs, based on previous data. From the beginning, the numbers related to ACOs and their success were less than staggering. For instance, the Centers for Medicare & Medicaid Services (CMS) reported that during the first performance year for ACOs, only 25 percent earned shared savings. While an additional 31 percent of organizations earned savings, they were not sufficient enough to achieve a shared savings payment. Meanwhile, the rest did not achieve any savings whatsoever.
"ACOs face the challenge of effectively coordinating care across different organizations."
"Alternative payment models, such as ACOs, serve to shift the traditional fee-for-service model, which incents providers to do more rather than do better, to a value-based model that aligns incentives with measurable quality, cost and population health outcomes," Timothy Lowe, director of healthcare research at the Premier Research Institute, said in a press release. "As providers develop and implement alternative payment models to align with value-based payment policies, such as the new Quality Payment Program for physicians, it is critical to identify what is working and what is not to support continuous change and improvement."
Simplifying and sharing information through healthcare technology
One problem in particular ACOs face is effectively coordinating care across different organizations. In fact, 79 percent of survey respondents said this represented a major challenge.
Utilizing clinical terminology software is one solution for streamlining this process. Terminology supplied by Intelligent Medical Objects (IMO) helps make sense out of complicated clinical information, simplifying patient documentation and facilitating the capture of clinical data.
IMO content integrates with numerous platforms and electronic health record (EHR) workflows, making it easy for ACOs to incorporate. In turn, organizations can better focus on accurate patient care while reducing workflow inefficiencies.
That said, since ACOs are comprised of disparate healthcare providers, another challenge has been the ability of organizations with different levels of health IT sophistication to share information with each other. In short, providers with more modern IT infrastructures are unable to easily share data with organizations that do not possess the latest healthcare technology tools.
A lack of proper technology has also impacted the ability of ACOs to comprehensively measure quality. Data from the Premier Research Institute showed the majority of survey respondents utilize quarterly CMS reports to measure quality effectiveness. However, less than half are able to see real-time data regarding the health status of specific populations. Meanwhile, only 32 percent of ACOs routinely examine health indicators in their geographic areas.
Perhaps most distressing, data from the Pharmacy Benefit Management Institute showed that less than a third of ACO providers use a single EHR system. While 59 percent use multiple systems, which significantly complicates data integration, 23 percent still use paper charts.
"The primary focus of ACOs appears to be a success."
A path forward
While there's no doubt ACOs face a number of challenges, it's not all doom and gloom for the organizations involved.
The primary focus of ACOs appears to be a success. The latest CMS data regarding Medicare Shared Savings Programs (MSSP) and the Pioneer ACO Model showed an aggregate quality score of 91 percent based on 33 ACO measures. This data accounts for 400 ACOs participating in the MSSP. Meanwhile, Pioneer results were almost identical, with an average quality score of 92 percent.
ACOs that earned shared savings appeared to have better quality scores. While the direct link between quality of care and money saved remains shaky, this data does illustrate a correlation between the two.
Data also indicated time is a factor in success. Fifty-five percent of ACOs that joined in 2012 earned savings in 2015. Meanwhile, only 21 percent of ACOs that joined in 2015 saw savings.
While there isn't much healthcare providers can do to speed up the benefits that come with experience in ACO operations, utilizing the right tools certainly helps them offer more effective care and minimizes the complications that come from using outdated technology.
Tools like IMO 2.0 ETP allow medical professionals to identify potential gaps between dictionaries and clinical quality measures, save time updating dictionaries through the use of automatic updates and ensure mobile documentation is both fast and clinically accurate at the point of care.
IMO clinical terminology is the most widely used in the industry - find out why.