ACOs face major IT challenges to improve cost and care quality, Commonwealth Fund says

Many of the 800 accountable care organizations are lagging in critical IT infrastructure, though commercial ACOs are earning more success today than their non-commercial counterparts.
By Mike Miliard
12:43 PM
ACO IT Commonwealth Fund

Photo credit: Leonardo Rizzi via Flickr. 

ACOs with commercial contracts are larger and more efficient than their non-commercial counterparts. But both types have something in common: They must make major investments in information technology if their success is to be sustainable, according to a new report from the Commonwealth fund.

The study examined three years of data (between 2012 to 2015) from the online National Survey of Accountable Care Organizations, looking at Medicare or Medicaid ACOs' organizational structure, provider compensation, efficiency and outcomes.

They also compared commercial and non-commercial ACOs on various quality measures, such as care coordination, patient experience, preventive care and at-risk measures.

Commercial ACOs tend to outperform public-payer ACOs on quality and cost but both "need to make major investments in critical infrastructure if they are to support delivery system reform," according to the report published in Health Affairs. 

Specifically, the report pointed to the need for tools to help with quality improvement coordination and managing physician financial incentives. But "the immature state of most ACOs' information technology platforms" isn't helping those efforts, the authors said. 

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Commercial ACOs are much more likely than noncommercial organizations to comprise multiple hospitals (41 percent vs. 19 percent), for instance – pointing to an acute need for interoperable electronic health records for more robust data exchange.

Notably, only 30 percent or so of commercial ACOs use a single EHR system. With noncommercial groups, fewer than 20 percent have members on one common EHR.

Commercial ACOs also more often tie physician compensation to quality incentives, meanwhile, but just half of them say they even monitor physician-level financial performance.

Indeed, ACO uptake of quality improvement initiatives in general has been "modest," according to the report. Even with larger and more complex commercial ACOs, barely 60 percent give performance feedback to their clinicians, or use patient satisfaction data for quality improvement. Just 30 percent say they have well-established chronic care programs.

"Today, more than 800 ACOs cover an estimated 28 million Americans, a figure that some expect to quadruple over the next five years," according to the Commonwealth Fund. "While larger, more mature commercial ACOs tend to score higher on quality measures and have more processes in place to improve efficiency than their non-commercial counterparts do, few ACOs of any variety report having rigorous quality monitoring processes or substantial financial incentives tied to quality." 

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