Commercial ACOs larger, more efficient, but lag on IT

At a time when all eyes are on the performance of accountable care organizations, ACOs tend to be bigger and operate more efficiently when they hold commercial contracts. But both commercial and non-commercial ACOs have work to do on information technology, according to a new report.

Researchers, led by David Peiris of the Harvard T. H. Chan School of Public Health, examined survey data from 399 national ACOs, analyzing the differences between 228 ACOS with commercial payer contracts and 171 that contracted with public payers such as Medicare and Medicaid. Not only did they find commercial ACOs had larger numbers of attributed Medicare beneficiaries, they were also more likely to encompass at least one hospital and be led by a combination of physicians and hospitals, according to the study, which was published in Health Affairs.

Uptake of quality and efficiency activity was low for both types, but among commercial ACOs, quality scores and disease monitoring were higher. Commercial ACOs were also more likely to have prior experience with payment reform models and risk-based contracts, and the commercial ACOs in the sample had a greater density of both primary care doctors and specialists.

However, the report found room for improvement across both ACO types, with information technology efforts considerably below their potential. Most ACOs overall have made investments in data analytics and IT to monitor quality, according to the study, but only 31 percent of commercial and 15 percent of noncommercial ACOs had a uniform electronic health record system in place. Researchers expressed concerns that ACOs’ minimal progress on IT capability is holding back overall delivery system transformation.

“Alignment with private-sector payment models remains a major barrier to delivery system reform, and state-led initiatives such as Maryland’s all-payer rate-setting system for hospital costs could serve as a model for future all-payer ACOs,” the researchers concluded.