Will ACO IT Models Be Walled Gardens or Open Platforms?

Will ACO (accountable care organization) IT models be walled gardens or open platforms?  i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.).

One POV: ACO’s Will Need Open IT Platforms

Mike Cummens, M.D., associate chief medical information officer at 750-physician Marshfield Clinic in Wisconsin, is quoted in a recent article in Healthcare Informatics. Dr. Cummens argues for an open ACO IT approach:

There will be an emphasis on transfer-of-care summaries and how to facilitate information sharing across the full continuum of care, he said. “For instance, you will have to work into care management plans the notification of home health agencies,” Cummens added. “In an ACO model, you will have to have methods in place to communicate all this information to providers who are not part of your own organization. People will have an option to see providers outside an ACO, so you will need to be able to transfer care summaries and discharge summaries outside the ACO.”

Also, because patient involvement is a key part of ACOs, the IT infrastructure will have to support patients signing off on their care plans and document their progress toward reaching goals, he noted. That will involve some type of self-management tools and personal health record access to their own data.

Cummens noted that the patient-centered medical home is geared toward an individual practice, and meaningful use metrics are geared toward providers, but ACOs will require managing data across enterprises. “When we visualize this and realize we are dealing with multiple electronic health records, the infrastructure for ACOs really has to ride on top of that,” he said. He sees the need for a new type of system, probably outside the EHR, that can bridge organizations, allow for risk assessment and analytics and reach down into tools for day-to-day management. That’s a tall order.

Reality: ACO’s Don’t Appear to Be Planning for Open Platforms

A report by PwC issued in June — Designing a health IT backbone for ACOs — found that providers are all over the map in thinking about IT requirements for their ACO.

Have you considered the IT requirements of an ACO?

No — 26%
Yes — 74%

(If “Yes”) How do you plan to address the IT requirements of an ACO?

Use existing internal systems — 39%
Utilize a planned local/regional HIE once developed — 19%
Through an existing local/regional HIE — 15%
Partner with another organization (e.g. a large IDN, a payer-driven initiative, community EHR, etc.) — 12%
Build own new IT infrastructure, systems — 11%
Other 4%

I found these answers illuminating:

  • 26% haven’t thought about IT requirements
  • “existing internal systems” of today are not geared for the specific needs of ACOs
  • Existing or planned HIEs are still immature ––  many (most?) aren’t yet up and running, they won’t include all providers, and they initially will share limited types of information

PwC concludes:

Most ACO discussions remain internally focused despite concerns about accessing external data

I predict that IT systems will quickly emerge as one of the biggest headaches for ACOs.

How Will this Play Out? Walled Gardens or Open Platforms for ACOs?

We’ll need to consider the question along several dimensions — both technical models and business models.  For example, its possible that ACOs might emerge having open technical models–yet have walled garden business models.

It’s also more useful to think about this question as a continuum of possibilities, rather than two discrete options. Walled garden IT and business models can have “walls” of varying heights and permeability.

My guess is we’ll see a lot of permutations. What are you seeing out there?

Vince Kuraitis, JD, MBA, is a health care consultant and primary author of the e-CareManagement blog, where this post first appeared.

5 replies »

  1. This is an insightful post.
    We’re already seeing organizations set their aim on becoming ACOs – and thus shelving the goal of interoperability with outside systems. Thanks for bringing this us.

  2. Richard, BobbyG
    I’m inferring from your comments that you suggest CMS should explicitly require more “open” ACO IT in the regs that are due out in January. I think that’s a good idea — ACO regs should reinforce rather than undermine HITECH regs.
    There is potential policy disconnect here. The HITECH regs are working toward open, interoperable health IT.
    Yet, by definition ACOs will be a closed network of care providers. Providers are economically incented to keep patients within their network, but patients will be able to seek care outside the provider network.
    IT vendors traditionally also have had closed, proprietary, non-interoperable business models. HITECH is changing this
    but clearly there are differences in how open EHR platforms are becoming.
    Matthew, I know where you can buy a unicorn. Send me your credit card number and I’ll take care of it for you. V

  3. Ian Morrison told me that ACOs were like Unicorns. Sounded beautiful, but no one had actually ever seen one of the mythical beasts. (Maybe Mark Smith’s line)
    I said that with the health plans buying the HIE vendors, they were putting up fences on unicorn farms

  4. “In Chapter Six, we discussed how CMS demonstrations projects such as the primary care medical home and accountable care organization models would shift the payment focus toward coordinated, integrated care. These models are potentially highly complementary to investments in health IT. CMS could further this connection and perhaps make these models more likely to succeed by requiring that demonstration sites have EHR technologies capable of more than reporting specified measures. These capabilities should include delivering and retrieving metadata-tagged, patient-centered, and patient-authorized information with other networks and sources such as PHRs and public health data aggregators. In addition, it will be important for CMS to document and publicly share what is learned about the contributions of such exchanges to the effectiveness of these new models and the results they achieve.”
    (PCAST Report, page 79)

  5. Interesting, but I think the answer to your question is, “it depends.”
    On what CMS puts in the regulations, that is. An increasing concern from providers is the potential for patient drift outside of the ACO. Will the ACO providers be compensated from Medicare if a patient of theirs sees an out-of-ACO physician? If the regs are silent on this issue, I don’t see what the incentive is for an ACO to open up their IT platform.