Lost in the ACO Desert

If you are scratching your head over accountable care organizations, you are not alone.

Many providers are “lost in the desert” of ACOs, Jacob Margolin, CEO of Clinigence, a health information technology company, said during a recent online presentation for the Healthcare Information and Management Systems Society (HIMSS).

“We know where the road should lead us,” Margolin said. “As far as how to get to those targets, there are really no clear paths or clear roads to tell us.”

It’s a complaint similar to many others that CMS has received following its release of the ACO proposal rule in March. Under the proposal, an ACO consists of a group of providers, jointly responsible for patient improvements and spending reductions.

Many organizations and providers are in support of the ACO program, but say the proposed rules for ACOs are too complicated, making the formation of, or participation in, an ACO inaccessible and daunting.

“Just because it’s voluntary [to participate in an ACO] does not mean that it’s simple to create,” said Shelley Price, director of payer and life sciences for HIMSS, another speaker during the conference. “The rule making is very complex.”

One of the most complex aspects of the proposed rules, and the one that is drawing the most criticism, is the 65 quality measures for use. These measures would ultimately determine the performance level of an ACO, and therefore the loss or reward that a particular ACO experiences. 

Though supportive of ACOs, the American Medical Association is criticizing this element of the ACO proposal.

“At this early stage, when there is so much we do not yet know about ACOs, a one-size-fits-all approach would be too restrictive,” the AMA said in a recent letter to CMS.

Tangled in Technology

Further complicating an already complicated system, health IT will play an essential role in ACOs. This may be premature, as the knowledge required to use technology effectively within an ACO may not yet be available for many providers, because they are still trying to master EHRs.

Twenty-six of the 65 measures for use in the ACO program come from the EHR meaningful use requirements. In addition, as the ACO is currently proposed, 50 percent of participating primary-care providers within an ACO must be meaningful users of EHRs by the second year of participation.

The requirements are understandable, as ACOs will need to use technology efficiently and effectively to benchmark and measure their progress, said Randy Thomas, a fellow at HIMSS during another presentation. The ACO must know where it stands in order to “identify problems and improve.”

Technology is also essential due to the size and nature of an ACO. Multiple providers will be working on the same case at once. Information within the ACO must be timely, available, relevant, complete, and accurate, Margolin said.

With the right technology, Margolin said providers can successfully master ACOs.

“If you want to drive improvements in real time,” he said, "you need to have timely information available to you.”