UC Berkeley

Objective. To assess the role of health information technology (HIT) in advancing the care management implementation of Accountable Care Organizations (ACOs).

Data sources/study setting. Data from the National Survey of Accountable Care Organizations (NSACO), a web-based survey of ACOs in the United States administered from October 2012 to May 2013, which includes data from 173 ACOs with either public or private payer partners. In addition, semi-structured interviews lasting 45-60 minutes were conducted between December 2012 and February 2013 with 20 leaders of 11 ACOs.

Study design. Retrospective cross-sectional analysis. A measure of ACO care management implementation was created from seven survey questions related to the following care management capabilities: chronic care programs, care transitions programs, and patient engagement activities (Cronbach's alpha = 0.84). HIT capability was measured using nine questions which asked about functionalities such as the extent of the primary ACO organization's inpatient and outpatient data integration, degree of electronic referral information exchange, as well as various electronic health record capabilities. For the qualitative analysis, constant comparative method was used to identify and code comments related to how ACOs were using HIT to capture, provide, and exchange information in general and in the context of care management in particular.

Principal findings. Multivariate regression using multiple imputation to account for missing data showed that HIT was associated with a significant increase in ACO care management implementation, controlling for factors related to the ACO organization, contracts, and financial motivation (0.38, p<0.001 and 0.19, p>0.001 for ACOs with single and multiple contracts, respectively). The relationship was then assessed when HIT functionality was categorized by its coordination role - information capture, provision, and exchange. Information exchange activities were found to be more greatly associated with ACO care management implementation as compared to information capture and provision activities (p<0.001). In addition, in the interviews we saw several examples of information provision, capture, and exchange using health IT in the care management context.

Conclusion. The findings suggest that HIT is significantly and positively associated with the development of ACO care management capabilities. HIT may play an important coordination role given the given the different types of coordination needed in delivering various aspects of patient care. Conceptualization of HIT coordination in ACOs may be useful to increase understanding of the relationship between HIT and care management.