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2018 ACO executive survey preliminary results

Apr 23, 2018

In early April, we launched our fourth annual ACO executive survey by email to our database of ACO contacts, which includes ACO executives and board members. We thought many of our readers would like to learn about some of the early highlights.

Our Take: Before we reveal a few of our more interesting findings, a word about our sample. We received 120 responses to the survey, representing nearly 4.8 million covered lives. The median number of covered lives per ACO was 25,000 (range: 5,000 to 500,000). On average, the ACOs in our survey were operational for 41 months (range: 3 months to 90 months).

Many participants are participating in several ACO models. Our sample distribution of ACOs includes MSSP (78 percent), commercial (41 percent), Next Generation (14 percent), Investment Model/Advance Payment (11 percent), and Medicaid (11 percent). Nearly 40 percent are in two-sided risk contracts.

We strive to make Our Take a quick read, so we’ve chosen five findings for our review today.

1. ACO executives are frustrated by a delay in getting data they need from payers. In 2018, 61 percent of respondents said they had a problem getting timely data from insurers, up from 50 percent in 2017. Many ACO executives have lamented delays in getting data back from CMS (and other payers), which affects their ability to assess performance in a timely manner.

2. Remarkably—in 2018—EHR system interoperability remains problematic for ACOs. Technology is the cornerstone of an ACO. If community physicians can’t communicate in real time with each other, with hospitals or with other providers, the model will underperform. In 2018, 60 percent of respondents cited EHR system interoperability as a problem, up from 55 percent in 2017.

In a separate question on EHR interoperability, only 8 percent of physicians said that all of the physicians are on the same EHR system as the hospital, and 17 percent said “most” physicians are on the same system as the hospital. Those two numbers have not changed in any meaningful way since we first started surveying executives in 2014.

3. People problems outweigh issues with technology. When asked about the singlemost important issue affecting their ability to provide the highest quality patient care, the top two responses totaled nearly 50 percent: physician engagement (24 percent) and patient engagement in their care / patient accountability (24 percent). And when asked about which issue has the greatest effect on their ability to control costs, physician engagement (23 percent) and patient engagement (18 percent) were the second and third-most cited responses. The greatest impediment to cost control? Keeping physician referrals within the ACO network (24 percent). No surprise there.

These issues aren’t new. Since 2014, both physician engagement and patient engagement in their care have been cited as significant barriers to controlling costs and providing high quality care.

4. ACO-pharma partnerships are rare, but on the rise. In 2018, 15 percent of respondents said they created an education or disease management program with financial support from a pharmaceutical company, compared with 6 percent in 2016. And 17 percent had executed a population health initiative with a pharmaceutical company—using data from the ACO’s patient population—compared with 9 percent in 2016.

5. Year after year, ACOs are increasing their contracting activity with other providers and suppliers. For example, in last year’s survey, 42 percent of ACOs had a simple or risk-based contract with a home health provider. In 2018, 49 percent were in a contract with a home health provider. Across the board—ambulatory care centers, nursing homes, medical device and even pharma-contracted relationships are growing.

One final point. We posed an open-ended question to executives about their top priority for 2018. More than half of the responses related to reducing costs, or reducing costs while improving quality. We see this as evidence that while ACOs are designed to keep budgets under control, many are still struggling to do so—regardless of plan type.

We will let you know when we’ve crunched the numbers and have a more thorough readout on the current ACO landscape. Data from our executive survey will also be included in a forthcoming update to our report on ACOs and value-based care.

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