A new survey reveals telling problems for multi-specialty medical groups when transitioning to value-based care, according to results released this week. The American Medical Group Association AMGA completed a survey of 101 member medical group practices and found the following top concerns:

Commercial ACOs

- Lack of access to administrative claims data

- Lack of transparency into cost and quality data

- Ineffective attribution methodologies

Federal programs

- Ineffective attribution, benchmarking and risk-adjustment methodologies

- Lack of standardized data submission and feedback processes

AMGA said respondents believe that revenues from commercial ACOs and partial and full-capitation will double by 2017, while ACOs and Medicare Advantage revenues will increase between 20% and 36%.

“Our members understand the importance of transitioning to a value-based payment system, in fact many are already moving in that direction,” said AMGA vice president for public policy Chet Speed. “This transition will be challenging and medical groups need policymakers and commercial insurers to partner with them to offer the tools they need to be successful in a new risk environment.”

Our Take: Data issues continue to hamper the effectiveness and efficiency of value-based reimbursement initiatives. As we discussed in last week’s issue, our most recent research with 126 ACO executives reveals EHR system interoperability to be the top concern among leaders, with 58% of respondent mentions. Nearly half say timely data from insurers is a problem, and a third have concerns with data accuracy. In fact, when asked about their biggest issue affecting the quality of patient care, 13% cite EHR system interoperability; one in ten say their system is the top concern affecting the cost of care—either in wasted time or money. About the same percentage say timely or accurate data is their number one concern affecting care or cost.

When asked, ACO executives point to different systems being used by hospitals and physicians part of the ACO. In our latest survey, we saw several comments with a similar sentiment: “Approximately 60% of physicians utilize the same system as the hospital with 20 other EHR vendors for the remaining providers.”

We applaud the free market for innovation, but ask a simple question: when will HIMSS or similar organizing body establish and enforce data interoperability standards, like the World Wide Web Consortium (W3W) does for HTML and CSS? When will CMS, NCQA and the Big 3 (or is it still the Big 5) payers get together and establish conventions for quality metrics? If the goal is to reduce costs and improve patient care, those establishing these initiatives would do well to remember that the effective use of technology is a founding principle of accountable care organizations—you can’t achieve meaningful cost reductions or care improvement without it.

“We have our challenges with Anthem and Aetna—data loading, eligibility and everything else,” one health system CEO recently told us. “And I’ll tell you about the CMS data. They changed their formats. They changed their fields. They didn’t give it to us when they said they would. It was very much of a problem.” 

That same CEO also lamented: “At one point, when I counted how many different metrics we had for these different plans or products, it was 208.”

Maybe the reason why Memorial Hermann has outperformed other MSSPs in shared savings can be traced back to its substantial investment in the Memorial Hermann Information Exchange, which has also allowed its clinical information network to blossom. Memorial Hermann has topped the list in Medicare bonuses for its ACO two years running. (The system has also been the subject of a 2014 data breach, but that’s another story and certainly not unique to Memorial Hermann.) Other leading systems in the ACO space like Banner Health and Partners HealthCare have top-shelf integrated data systems.

It is worth mentioning that the CEO we quoted here has a novel system to deal with the complexities of data integration and tracking quality metrics: With a color-coded Excel spreadsheet.

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