Safety nets: Health IT a barrier to ACO formation

A pilot survey of healthcare safety net institutions in California has found that they have a shaky health IT foundation for forming accountable care organizations. A policy brief on the survey, from the University of California Berkeley School of Public Health, recommends additional state support for these organizations so they can meet the Meaningful Use objectives of the federal electronic health records incentive program.

Written by Stephen Shortell, dean of the UC Berkeley School of Health, and graduate student Sarah Weinberger, the report includes results from a survey of safety net organizations in Alameda and Orange Counties that together oversee or provide care to 423,000 Medicaid and uninsured patients.

The respondents were asked about their preparedness to form ACOs in eight domains. On average, they ranked their readiness on health IT infrastructure lower than on all but two other categories: finance/contracts and legal/regulatory issues.

The authors commented, "As expected, respondents reported the need for greater capabilities with regards to electronic health record functionality including using disease registries, embedding practice guidelines, incorporating information from non-participating providers, and constructing electronic patient communication and engagement tools."

Interestingly, however, the organizations rate their preparedness higher in the areas of managing clinical care and performance reporting. Both of those areas require a strong health IT infrastructure in an ACO environment. The report recognized that not only these, but all of the other domains are interdependent.

The respondents said they found implementation of electronic health records to be challenging; in response the authors suggested that the California Department of Health Services "provide assistance to safety net provider organizations to allow them to take full advantage of the financial incentives (federal and otherwise) to adopt and implement electronic health records and to participate in Health Information Exchanges through Cal E-Connect and other initiatives."

The American Medical Group Management Association (AMGA) provides another survey instrument that can help physician groups assess their ACO readiness. In the health IT category, the survey includes 10 measures that show whether the group's health IT infrastructure "supports efficient and effective practice and also tracks and reports on cost and quality of care."

The Accountable Care Collaboratives of Premier Healthcare, a big group purchasing organization, also consider health IT to be a prime indicator of ACO readiness. The Premier exhorts the collaboratives to "evaluate population health information infrastructure, including electronic medical records, that enable community-wide care coordination efforts."

To learn more:
- read the UC Berkeley policy brief (.pdf)
- see the AMGA ACO readiness assessment (.pdf)
- check out the Premier Accountable Care Collaboratives brochure

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