Interoperability and Accountable Care Organizations

As the U.S. healthcare system continues to embrace the possibilities of the digital age, there still are obstacles standing in the way of medical and IT professionals alike. One crucial issue is maintaining high quality health care while lowering costs and increasing efficiency. Accountable Care Organizations (ACOs), created to improve patient care while lowering the incurred cost of healthcare, are an attempt to clear this roadblock.

ACOs are made up of healthcare providers who work together to facilitate care for a target group of patients. Smooth, streamlined healthcare is the goal for ACOs. Customer service is the focal point, with patients entrenched firmly at the center of their established care models. ACOs have three main operating principles that dictate what they look to accomplish:

  • ACOs are provider-led organizations focused mainly on primary care.
  • An ACO’s purpose is to improve care while reducing expenses.
  • Performance measures have to be backed by tangible proof of results and they have to be reliable.

Benefits of Interoperable ACOs

Interoperability is the ability of different IT systems and various software applications to communicate, exchange and disseminate information among themselves.

An ACO must be able to share information in its network of providers and organizations seamlessly, securely and promptly across the continuum of care. The continuum of care provides several major benefits to patient care. According to GSI Health, some of the advantages are:

  • Improved care coordination
  • Widespread health promotion
  • Improved patient and family support services.

The Challenges ACOs Face

ACOs face their own issues. They operate under specific requirements, mandating that they prove they coordinate patient care and promote evidence-based medicine supported by facts and figures in reports about their quality and cost measures. In order to report the information correctly, ACOs have come to rely on health IT frameworks and infrastructure, but it’s there that interoperability sometimes is lacking.

survey by Premier Inc. and eHealth Initiative found that 95% of professionals responding reported that interoperability within varying systems is a major cause for concern.

Some ACOs report that dealing with health information service providers can be difficult. Many don’t offer anything beyond very basic services. Even something as simple as trying to acquire accurate and up-to-date directories of providers and facilities from partner organization organizations can take far too much time, ACO administrators have reported. Getting more detailed information from other clinics and providers can be even more time-consuming.

The more technology needed to bridge the gap between ACOs, the greater the operating costs will be. According to the survey, as ACOs pull data from more sources, they also report more difficulty leveraging their health IT infrastructure to support what the ACO is intended to do. Their technology and resources are stretched too thin, and it’s creating interoperability issues.

In an interview with HealthBiz Decoded, Bill Beighe, chief information officer at Physicians Medical Group of Santa Cruz County, said: “To attain true interoperability, EHR (electronic health records) vendors would have to agree to the same data standards, but they are too competitive to do so. Thus ACOs and other providers that want to share data have made end-runs around the systems.”

The nature of internal competition in the healthcare industry seems to be stacking more hurdles for ACO professionals to jump.

The industry as a whole recognizes those problems. Enabling interoperability among disparate systems would have advanced healthcare IT more than any initiative the federal government actually implemented, Dan Haley, vice president of government and regulatory affairs at the cloud-based EHR vendor Athenahealth, told InformationWeek, “In 2015, the notion you can have ‘meaningful use’ of information technology that does not enable interoperation is ridiculous. You could strip away all the other requirements and only require interoperation,” he said.

Staffing Challenge

Finding professionals ready to step into ACO roles is another issue. ACOs use advanced technology to share information between healthcare providers. They need skilled professionals to operate their systems, but are having a hard time finding them. According to labor market analytics firm Burning Glass Technologies, health informatics jobs are staying open longer than the national average, meaning employers might be having difficulty finding candidates with the right qualifications. Many of these positions are hybrids, meaning the roles they require are blending skills that might not have been paired together in the past, creating a learning curve for professionals looking to enter the field.

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EDWs and Interoperability

There is, however, a school of thought that holds the interoperability issue is not as severe as many believe. ACOs usually are formed within a single organization, and data that is transferred back to the ACO from payers is usually imported directly to an enterprise data warehouse (EDW).

But EDWs also can be an aid to interoperability. An EDW with a Late-Binding architecture can help ACOs streamline data systems and increase efficiency in a matter of months. They allow interaction with physicians to determine diagnosis and procedure codes that best define a particular population. They also allow ACOs to understand the cost of caring for those populations. This process quickly enables an ACO to build flexible, accurate registries that can be adapted based on physician input. They can also adapt easily to the changing needs of an organization.

The Future of ACOs

ACOs bring a new dynamic to the healthcare industry. Primary care physicians, specialists and rehabilitation centers now have to work together to provide a cohesive form of healthcare, instead of a fragmented one. It remains a work in progress.

Moving forward, large scale employers and individuals alike might prefer the lower price ACOs can offer. As time goes on and more people work with ACOs, there’s a chance they will become more proficient at offering quality healthcare services for less money.

To date, there are more than 600 public and private ACOs. In the first year of the program, 2012, $87.6 million in gross savings was generated. Government support is spurring considerable growth, ACOs are rapidly growing with government support and they could become the dominant model in healthcare sooner rather than later.

A Master of Science in Health Informatics from Jacksonville University can help you transition into a new field or move up in your current one. It’s available 100% online.

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