In their second year, the Center for Medicare & Medicaid Innovation’s 32 Pioneer accountable care organizations (ACOs) are gleaning many nuggets of wisdom in their bid to achieve the triple aim of improved care, improved health and lower per-capita costs.
Pioneer ACOs are cutting edge among Centers for Medicare & Medicaid (CMS) ACO programs in their efforts. In 2012, Pioneer ACOs began testing various payment arrangements that offer higher levels of risk and reward as compared to other ACO programs, including the Medicare Shared Savings Program. To that end, ACOs are held financially accountable for the care delivered to their patients, as well measurable health outcomes for these individuals.
“I liken Pioneer ACOs to a poker hand,” says Brian Hodgkins, PharmD, executive vice president of Heritage ACO, a pioneer ACO covering 90,000 beneficiaries in central and southern California. He spoke during a California Healthcare Foundation webinar in April. As the risks will be higher, the need for strong IT strategies is especially essential to positively impact quality measures. “We’re starting to see that data are everything. Data and IT systems are probably going to be the most strategic parts of any ACO,” he says. “Success is within your ability to manage data, and understand population management shifts and risk stratification.”
For Pioneer ACOs, strong data strategies are critical to making progress on improving CMS’ quality measures. However, these ACOs are reporting many stumbling blocks in optimizing IT systems.
In the Michigan Pioneer ACO, which encompasses 800 primary care physicians (PCPs) and 1,200 specialists who cover 23,000 Medicare beneficiaries, the move to a new EMR proved challenging.
“Change is always hard. We had a homegrown EMR that was customized to our clinical workflows and our physicians were well versed in how to use that but it lacked a lot of functionary that is necessary for Meaningful Use,” Timothy A. Peterson, MD, MBA, medical director of population health and medical director of Pioneer ACO at University of Michigan Health System, told Clinical Innovation + Technology in reference to his organization—a major player in the ACO.
From an IT perspective, he says reporting on quality measures proved difficult as participating providers operated in a variety of EMRs.
“One private office still is on a partial paper system,” Peterson says. “It’s increasingly clear that it’s imperative that EMRs figure out a way to talk to each other. It is not going to be a long-term, sustainable solution for each physician group or health system to be locked into an EMR with a proprietary software system that cannot trade information with all other software systems.”
Lack of interoperability also surfaced as a major issue at Beacon Health, a Pioneer ACO that includes more than 14,000 Medicare beneficiaries from the Eastern Maine Healthcare System (EMHS) and other organizations.
During the first year, the EMHS providers used the same inpatient and outpatient records, but as more outside entities joined the ACO, IT challenges came to the fore.
Iyad Sabbagh, MD, MBA, medical director for accountable care activities at EMHS, reported on the struggle in handling a multitude of EHR systems at a February webinar hosted by the statewide coalition Maine Quality Counts.
“Year two brought challenges because all the new organizations that came on board had different systems and different platforms. One lesson we are learning right now is how to input information and extract it from the EHRs and how to capture and report it,” he says.
The differing connection speeds at the organizations also posed challenges, and the ACO had to factor in how fast data flowed in and out of Maine’s HealthInfoNet, the state’s health information exchange (HIE), Sabbagh adds.
The Maine ACO developed a framework that moved IT through four different levels including case management, panel management, operation analytics and strategic analytics.
“Our IT department initiatives are in place for our accountable care collaborators,” he says, explaining that they built electronic tools that provide data on patients. Once they receive the beneficiaries’ claims files, they pull quality data from the HIE and that tool allows risk analysis and predictive modeling of the patients, leading to better care coordination, he explains.
Risk stratification & care coordination
Using data to target beneficiaries that are high utilizers, or those with