Why Interoperability of ACOs Improves Patient Engagement


As our world grows more interconnected, healthcare follows suit by making it easier for Medicaid organizations to work together on behalf of their beneficiaries and their own organization. Improving Accountable Care Organizations (ACOs) and helping them work together with greater efficiency has been a common goal for CMS and other organizations. The healthcare environment is promoting coordinated and value-based care with increased vigor. These efforts are providing new tools to help ACOs accomplish these objectives and avoid risks through working together, broadening their reach, and improving their impact.

The idea of ACOs is itself a recent innovation, with the first ACOs forming shortly after the passage of the Affordable Care Act. Since their appearance, they have grown more popular as organizations see how they help combat rising medical costs, improve coverage for patients, and expand coverage for population health outcomes. Even national payers like Aetna and Humana have invested significantly to expand the availability of ACOs.

In 2016, interoperability of ACOs was the number one challenge faced by their administrators. Since that time, CMS has worked to alleviate those burdens. They have paid particular attention to increasing interoperability with behavioral health and long-term/post-acute care. As CMS has worked to expand behavioral health services (such as drug and alcohol abuse, discussed in our blog about 42 CFR Part 2, they have worked to address privacy concerns many beneficiaries have about the sharing of their information, and worked to build patient confidence in the security of their information that is being shared. Allowing patients greater control over how and with whom their information is shared has been a significant factor.

For ACOs to be successful, they must be able to share essential information about their patients. This exchange usually occurs when one provider sends a Continuity of Care Document (CCD) to another provider when the patient is discharged or referred. This electronic information exchange can provide challenges for ACOs, particularly for those outside their traditional network.

Len Levine, a consultant in Massachusetts who works with eHealth Collaborative and Massachusetts Health Information Exchange, recently discussed the following difficulties and strategies to better facilitate harmonious interoperability of ACO as they electronically exchange information:

  • Logistics: Information sharing happens between multiple providers who may be using different systems. Users may need to be trained on different systems. Creating teams of providers, coordinators, case managers, and IT staff from each ACO will increase interoperability efficiency by jointly defining requirements for shared information and managing the handoff of the information across various organizations.
  • Format Compatibility: Different types of information exchanged for ACO care coordination may require the use of different document types.
  • Content Validation: ACOs may need to exchange more types of information than is currently captured in most CCDs using the minimum meaningful use data set. Content requirements should be evaluated and validated prior to making any technical or workflow changes.
  • New Users and Steeper Learning Curves: Caregivers may be new to electronic information exchange. ACOs may need to provide technical and operational assistance to affiliated organizations lacking the internal expertise or resources to manage this exchange.

Beyond data sharing, other tools to increase ACO interoperability include patient engagement and population health management. Aetna and Humana have played larger roles in helping ACOs advance patient engagement and outreach. They are also partnering with ACOs to expand preventive care into rural and new territories. Payers are embracing more and more risk as they transition to two-sided shared savings models and further cement their commitment to working with ACOs towards their shared objectives.

Amy Oldenburg, Aetna’s Vice President of Network and Product Strategy Accountable Care Solutions, recently declared, “We believe transforming health care will help reduce waste, improve quality, improve member/patient satisfaction, and improve overall health and productivity.” Regarding their investment of time and resources to help ACOs, she said Aetna sees the efforts as “well worth the commitment.” Oldenburg also indicated that “true transformation is a long-term endeavor” and reaffirmed Aetna’s commitment for the long haul to their partner ACOs. Commercial payers are seeing financial benefits of promoting interoperability with ACOs as the results have yielded more satisfied—and loyal—patients. As ACOs unite to work with these payers, they may even increase their leverage in negotiations as they enhance their performing power and efficiency by working together.

Cooperation is at the core of what makes ACOs work. As healthcare embraces the Whole Person Care philosophy, payers, providers, physicians, and patients are increasingly working together to reduce costs and increase overall efficiency in healthcare. Mirroring these collaborative efforts, ACOs are made more effective as they facilitate better interoperability and embrace a more collaborative approach to care. As ACOs work together through increased interoperability, they will find better tools to help them make the transition and reap the benefits more quickly.

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