Why OIG Did This Review. This evaluation provides insights into how select ACOs have used health IT tools to better coordinate care for their patients. It can help ACOs anticipate challenges they might face, and it can help the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) assist ACOs in overcoming those challenges. Health IT has significantly enhanced providers' opportunities to coordinate patient care across healthcare settings. Medicare patients often have chronic medical conditions that require care from multiple providers. Care coordination helps ensure that patients' needs for health services are met over time and across multiple encounters and settings. CMS has identified care coordination as integral to achieving better care, improved health, and lower costs. CMS has implemented various payment models for promoting these goals in Medicare, including models that use ACOs. How OIG Did This Review. We based this data brief on interviews we conducted during site visits to six Medicare ACOs (four were Next Generation ACOs and two participated in the Medicare Shared Savings Program). We considered the following factors when selecting ACOs: their performance on a quality measure focused on care coordination and patient safety, a minimum of 3 years of experience as a Medicare ACO, geographic variation, and recommendations from CMS and ONC. We discussed with ACO administrative staff and providers how ACOs use health IT to coordinate care for their patients. What OIG Found. Overall, health information technology (health IT) tools have enabled the six Medicare accountable care organizations (ACOs) we visited to better coordinate patient care. (An ACO is a network of doctors, hospitals, or other healthcare providers that come together voluntarily to coordinate high-quality care for their patients.) ACOs that used a single electronic health record (EHR) system across their provider networks were able to share data in real time, enhancing providers' ability to coordinate care. A small number of ACOs had access to robust health information exchanges, which give ACOs access to patient data even when patients see providers outside the ACOs' networks. Most of the ACOs we visited used data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions. However, the ACOs we visited still face challenges in these areas. ACOs that used multiple EHR systems had to rely on other means to share data among providers, either using additional health IT tools or relying on phone calls and faxes. Although EHRs are intended to streamline, coordinate, and improve care, ACOs report that EHRs can also be burdensome and frustrating for providers. ACOs also faced challenges from physician burnout due to the workload of managing EHRs. Most of the ACOs had access to health information exchanges with little or incomplete data, making it difficult to coordinate care when patients saw providers outside the ACOs' networks. Few of the ACOs use analytics to customize care to an individual patient's needs. Finally, few ACOs offer health IT tools to patients, other than online portals to their EHRs. What OIG Concludes. The ACOs we visited have used health IT to aid in care coordination in a variety of ways. However, the full potential of health IT has not been realized. ACOs vary in the extent to which they can rely on health IT tools, in some cases because those tools cannot reach all providers involved in a patient's care, or because the tools lack the necessary information that ACOs need. Achieving the interoperability needed for seamless care coordination places burdens on ACOs to either invest in a single EHR system or use other methods, such as non-health IT means, to communicate health information.
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