In less than two years we have gone from Accountable Care Organization (ACO) as a concept, to ACO as a new model of care delivery. With the January announcement that there were 106 more added to the Medicare ACO program, we now have 254 ACOs nationwide. David Muhlestein of Leavitt Partners has done some of his own research and puts the total number of ACO-like entities at over 400. And let’s not forget that commercial insurers are putting forth their own contracts with providers to set-up similar accountable delivery systems where there is some element of gain and risk sharing with providers.
Now it is one thing to say you have signed on to become an ACO and quite another to actually execute on the contract. Among the numerous challenges that an ACO model presents, is the need for more sophisticated IT systems that will support distributed care management across a diverse care team that extends from the primary care physician, to the specialists, to the care manager, the patient and others. EHRs today will simply not get you there.
Today, there is no such out of the box solution from any one vendor that will enable an ACO model. But there are several vendors positioning themselves to be that one stop shop to enable your ACO strategy.
Following are some vignettes of several vendors looking to enable an ACO strategy and what they have on offer. (Note: This is our proverbial toe-in-the-water as we’ll be doing a comprehensive report on this market later this year)
Aetna: A commercial payer, Aetna is looking for new high-growth revenue opportunities and has targeted healthcare IT. Shortly after acquiring leading HIE vendor Medicity, and soon after leading mHealth App iTriage the company announced its ACO-enablement suite that combines the two above with analytics/managed care solution Active Health.
Strengths: Strong HIE brand, good consumer/patient engagement tools
Weakness: Predictive analytics and care management tools are not as competitive
CareEvolution: A privately owned HIE targeting the private, enterprise market, the company has built its own analytics engine, Galileo. Galileo provides deep dive capabilities into clinical, operational and claims data contained within a given network of providers.
Strengths: State of art HIE solution, good analytics capabilities
Weaknesses: Consumer/patient engagement tools are almost non-existent, low recognition in market
Cerner: Cerner’s HealtheIntent is part of the company’s broader strategy to move beyond being an IT company to becoming a health company. Like most EHR companies, ability to move as fast as market requirements is a challenge.
Strengths: Leading EHR, strong brand, leading visionary among EHR companies, has a good HIE solution, has broad suite of consumer engagement tools
Weaknesses: Analytics is lagging, resources to respond quickly is a challenge, distributed care management tools still work in progress
Epic: Company has one objective, rule all and do so through a highly proprietary and closed model. With Epic Everywhere, their HIE solution for Epic sites, company is able to provide exchange across entities as long as they are using Epic. Recently signed deal with Surescripts to allow exchange with other EHRs. Epic’s MyChart is the leading patient portal in the market.
Strengths: Growing dominance in market, solution suite is tightly integrated from ambulatory to acute care settings, patient portal is widely adopted
Weaknesses: Epic continues to follow a dated model of highly controlled, closed system that while providing high integrity, will ultimately yield a lumbering dinosaur – think Wang circa 1983
RelayHealth: Part of McKesson, RelayHealth has always been a catchall for various acquisitions that McKesson could not find an appropriate home for. A major reorg occurred a couple of weeks ago that will reposition RelayHealth as McKesson’s ACO-enablement suite.
Strengths: Strong consumer/patient engagement tools, a leading HIE solution in the enterprise market and with the reorg, the addition of new assets including the recently acquired analytics solution, MedVentive
Weaknesses: Still does not have a good story to tell around distributed care management, how MedVentive will be folded in remains to be seen.
This is by no means an exhaustive list of those HIT companies looking to offer an ACO-enablement solution suite, but simply meant to provide some perspective on what is currently on offer in the market.
As we prepare to head to HIMSS a week from Saturday, on the top of our list of things we wish to learn more about is exactly how companies such as those listed above and others not listed are meeting the current and future needs of the 400+ ACOs across the country and more importantly, how they intend to become the leaders in this rapidly developing field.
Thanks to KramesStayWell.com for the image
[…] the fluffy clouds that house the data rooms in the sky we are starting to embrace. In a recent article John Moore of Chilmark likened Epicâ€™s closed system strategy to Wang Laboratoriesâ€™ […]
[…] exist among the fluffy clouds that house the data rooms in the sky we are starting to embrace. In a recent article John Moore of Chilmark likened Epic’s closed system strategy to Wang Laboratories’ protectionist approach, and we […]
[…] still exist among the fluffy clouds that house the data rooms in the sky we are starting to embrace. In a recent article John Moore of Chilmark likened Epic’s closed system strategy to Wang Laboratories’ protectionist approach, and we all […]
When does the funding at ONC decline or go away?
When does state level HIE funding stop?
Which regional HIEs will be able to provide real services to ACOS and CINS with real functionality in the short term with actual services and not just light weight services like Direct which those organizations could provide for themselves?
Great work on HIE vendor review. When will you tackle the BI and Analytics as a real possibility for state level HIEs or regional HIEs with competitors in the HIE like those in Indianapolis or Cinn or Chicago?
Here’s some ACO/IT information – as of Jan. 2013
I thought you’d like to review how Epic is doing. Marty
Very informative blog!HIE is the mobilization of healthcare information electronically across organizations within a region, community or hospital system. According to an internal study at Sushoo Health Information Exchange, the current method of exchanging patients’ health information accounts for approximately $17,160 of expenses annually for a single-clinician practice. Thanks for sharing.
An interesting number there. Is that the total cost to a physician to participate in the HIE (eg cost to subscribe, expense due to workflow disruption, etc.) or is it the savings derived to the community via lower healthcare costs/physician (lowering of duplicate tests and the like)?
[…] From what I understand, the most popular EHRs are closed systems. In best case scenarios, people can look, but they can’t touch, correct, or create tools with the data. To take one example, the standard contract for Epic is so restrictive that Paul Levy has described their customers as victims of Stockholm syndrome. John Halamka has compared its sweep to the Invasion of the Body Snatchers. (For a less dramatic comparison of major EHR vendors, read John Moore’s rundown.) […]
[…] The most popular EHRs are closed systems. In best case scenarios, people can look, but they can’t touch, correct, or create tools with the data. To take one example, the standard contract for Epic is so restrictive that Paul Levy, former President and CEO of Beth Israel Deaconess Medical Center in Boston, has described their customers as victims of Stockholm syndrome. John Halamka, Chief Information Officer at Beth Israel, has compared its sweep to the Invasion of the Body Snatchers. (For a less dramatic comparison of major EHR vendors, read health information technology analyst John Moore’s rundown.) […]