OIG: Medicare ACOs have yet to realize full potential of health IT

doctor and technology
The Department of Health and Human Services Office of Inspector General says health IT is not living up to its potential in accountable care organizations. (metamorworks/Getty Images)

Medicare accountable care organizations aren't using electronic health records to their full potential, a new report shows. 

The report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) gathered data from across six ACOs, some of which used a single EHR across provider networks and were thus able to share data in real time. Some of the included ACOs had access to health information exchanges (HIEs) that allowed for access to patient data even when the patient was treated outside the ACO network.

In addition, most of the ACOs used data to group patients according to the potential severity and cost of their health conditions.

For those ACOs in the report that used a single EHR, the group was able to provide a portal containing patient care checklists, available to all providers. As a result, all members of a patient’s care team had information in real time on the patient’s health status. Also, notes in the portal could be forwarded to care teams and specialists. 

IT tools have been implemented by ACOs to enhance patient support, the study found. Plus, the Centers for Medicare & Medicaid Services (CMS) has been active in pushing ACOs as a way for patients to get the right care without unnecessary duplication of services. And one key area of focus for the shift to value-based care is maximizing the potential of health IT.

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However, care was not seamless for ACOs using more than one EHR system. And for one ACO that was visited in the study, providers not using a compatible EHR system ran into issues such as read-only access to certain files and data that were not received in real time. Therefore, analysts concluded that ACOs with multiple EHR systems could not rely on EHRs to play a central role in care. 

The OIG researchers warned that there were several challenges associated with EHRs for both single or multiple systems, such as staff burnout. This also includes additional workload and fatigue from constant EHR alerts for patient notification, ultimately detracting from physician time with patients. 

For those using HIEs, ACOs reported that they supplied a great deal of useful patient data, but when data were incomplete it made coordination difficult. 

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Two of the ACOs visited by the HHS team had gathered useful patient data. One ACO had an independent, member-run HIE that was partially funded by the state. Most hospitals in the state belonged to it, allowing for a single data source. Yet another ACO used third-party health IT to make sure all providers in the network were compatible. 

Another inherent challenge with HIEs is the ability to share data with providers outside of the ACO network, according to the report. In fact, one physician in the report said getting data from outside providers can take so long it is often faster to redo a test. 

Most of the ACOs visited used data to group patients by risk and cost of health conditions. Using these data, ACOs could specialize in outreach and coordination strategies to manage conditions. Some of the ACOs said they used data to create community anti-smoking campaigns or assign risk scores to patients, but few ACOs were using the data to customize care to patients. 

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In addition, many ACOs cited challenges with collecting information regarding social determinants of health and then how to use these data once collected. 

The report also flagged a lack of patient use of tech tools. At a minimum, each ACO offered patients access to an online portal with EHRs, but use of these portals varied. 

Between May 2011 and July 2018, CMS paid Medicare ACOs incentive payments for EHRs totaling nearly $25 billion. And those investments are beginning to show savings: Medicare Shared Savings Program ACOs saved Medicare $2.7 billion by 2019, according to an analysis from the National Association of ACOs