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How Interoperability, Care Coordination Work to Improve ACOs

Driven by care coordination, Next Generation accountable care organizations rely heavily on interoperability.

By Sara Heath

Interoperability has come to the forefront of health IT conversation, particularly as the industry emphasizes patient-centered outcomes, team-based care, and care coordination. All of these concepts have become a cornerstone of the healthcare industry, particularly with the emergence of accountable care organizations (ACOs).

health IT interoperability accountable care

ACOs utilize team-based care by requiring providers to work together, coordinate care, and improve patient health across different care facilities and specialties. At the center of all of that is health IT interoperability, because each member of the care team must be able to quickly and securely exchange patient health information across digital platforms.

But where is the industry right now in terms of improving care coordination through interoperability? How is the industry working to connect health IT platforms to help drive ACOs?

Through ACOs, and the Next Generation ACO model specifically, the healthcare industry is seeing interoperability and care coordination working together to improve patient care.

CMS introduces Next Generation ACOs

READ MORE: Health Information Exchange in New York Continues Growth

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) began a new ACO program referred to as the Next Generation ACO model.

This model builds upon the earlier Pioneer ACO models and the Shared Savings Program.

“Unlike other models, this model includes a prospectively (rather than retrospectively) set benchmark, allows beneficiaries to choose to be aligned to the ACO, and tests beneficiary incentives for seeking care at Next Generation providers, including increased availability of telehealth and care coordination services,” explained Department of Health and Human Services secretary Sylvia Burwell in a public statement in January.

Interoperability is a key driver for success in this new model, which poses greater risk for participants but also greater rewards. By pushing providers to work together through connected health IT, the industry sees a dire need for better support and connectivity between systems.

Limited interoperability poses threats to ACOs

READ MORE: ONC Interoperability Roadmap Targets Learning Health System

Between Congressional efforts and different private industry projects, experts are putting a clear emphasis on improving interoperability. As such, it’s not surprising that lacking interoperability hampers the process tremendously. With ACO success hinging on adequate care coordination, it’s important that providers be able to utilize each other’s EHRs interoperably.

"Ideally, I would like to go into my EHR  and then when I needed something from someone else’s, I’d be able to easily tap into their EHR and look at it and pull out whatever information I needed," Advocate Contact Center Medical Director Jennifer DeBruler, MD, told EHRIntelligence.com in an interview last year.

However, DeBruler said that’s often not the case.

"The process of trying to get a hold of other physicians and their offices, to get documentation and counsel, is a big barrier to getting the information,” she said.

Other experts are expressing the same views, underscoring the need for interoperability and care coordination in ACOs. In a report from the eHealth Initiative and Premier Inc., researches showed how interoperable health IT plays a major role in making ACOs possible.

READ MORE: CMS Sets Sights on Interoperability, Information Sharing

“As ACOs pull data from more sources, they also report lower abilities to leverage their health IT infrastructure to support care coordination, patient engagement, physician payment and contract adjudication, population health management and quality measurement,” the report explained.

Others claim that without interoperability and care coordination, there might be little payoff in participating in an ACO. If ACO members aren’t able to share information with one another to reduce duplicative procedures and other excess costs, then they likely won’t see the financial rewards of the demanding program.

When providers are able to execute ACO goals through care coordination and interoperability, they are able to create more buy-in for the program.

“Once members see the benefits of ACO care coordination for themselves, they convince their doctors to become advocates of the program,” said Dr. Daniel Bluethsome, Chief Medical Officer at Santé Community Physicians IPA. Bluethsome’s peers in an Anthem Blue Cross ACO were able to save $7.9 million in just one year.

As health IT continues to improve, interoperability will ideally follow, allowing ACO members to practice better care coordination, and eventually see the promised benefits.

What the industry is doing about interoperability

This pressing necessity for better interoperability is not going unnoticed. Throughout the healthcare space, public and private groups are working to make truly interoperable systems a reality.

Most recently, the Senate Committee on Health, Education, Labor, and Pensions passed a bill to the Senate that would increase interoperability and alleviate provider stressors.

The Improving Health Information Technology Act will improve physician EHR use, decrease data blocking, make health IT patient-centered, increase transparency, and boost interoperability.

The 21st Century Cures Act has also made its way through Congress, getting passed in the House of Representatives in a 344 to 77 vote back in July. The bill is currently circulating the Senate.

The 21st Century Cures Act include provisions to improve interoperability and precision medicine, and bolsters clinical trials and big data analytics systems. It also streamlines drug approvals, creates a 21st Century Cures Council, expands access to breakthrough drugs.

The bill’s interoperability policies provide better funding to the National Institutes for Health (NIH) to create national standards for better connected health IT systems.

The private sector is also trying its hand at improving interoperability. Projects like the Carequality, a part of the Sequoia Project, are some of the latest efforts on the private sector side of things.

Carequality creates agreements between vendors to create a framework that enables seamless transition of health data. Vendors who are a part of Carequality include Epic Systems, eClinicalWorks, NextGen Healthcare, and Surescripts.

Vendors who have signed onto the framework tout its potential to make ubiquitous interoperability a possibility.

"As vendors, we have a responsibility to make information accessible to patients and their physicians," eClinicalWorks CEO Girish Navani told EHRIntelligence.com earlier this year. "The work done as part of the Carequality Framework will speed the time from end user agreements to being able to go live with real interoperability between disparate systems. This initiative will aid our customers in sharing pertinent health data and providing better care."

Other private sector interoperability efforts are also booming. The CommonWell Alliance, a vendor-led interoperability effort, has recently added five new program members to its ranks.

Led by Cerner Corporation, Allscripts, and athenahealth, the CommonWell Alliance added ImageTrend, lifeIMAGE, Mana Health, and MediPortal. This brings the alliance’s total members to 40.

Efforts toward interoperability aren’t just limited to EHRs. Efforts like HL7’s Fast Health Interoperability Resources (FHIR) creates a way for health app developers to make apps that will work on more than one health IT interface. This will help create a health app market that can cater to multiple systems, allowing those working on one system to share app data with others working on a different system.

Overall, stakeholders and vendors believe these private sector interoperability programs present a great opportunity for the emergence of better ideas to help create seamless transitions of health information. Between both Carequality and CommonWell, as well as FHIR and efforts like the Argonaut Project, health information becomes far more mobile and can move between different providers, regardless of their disparate health systems.

"The industry needs to evolve from simply exchanging information to meaningfully sharing it and introducing new workflows to access it," said Doran Robinson, athenahealth Vice President of Healthcare Transactions. "We believe that efforts such as Carequality, CommonWell and the Argonaut Project are making marked progress on mobilizing health care information in meaningful and secure ways.”

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