KLAS: Third-Party Vendors Cornering the ACO Market

When it comes to meeting the needs of physician-led ACOs, which are becoming increasingly common, third-party ACO vendors are getting a leg up on the competition, according to new research from KLAS.

The report — Physician ACOs 2014: Variations on the Accountable Care Theme — found that physician organizations now lead more ACOs than hospitals and IDNs, with a majority of earning bonuses being physician-led, despite a perceived lack of capital and established care networks.

Third-party vendors are picking up the slack where EMR vendors lag, performing higher in all functional categories, most notably risk stratification. According to the report, 68 percent of respondents use a third-party vendor, while 15 percent rely on an EMR provider. Advisory Board, MEDecision, Optum, and Phytel are the vendors most often deployed.

Overall, EMR vendors are not ready for ACO prime time, rating on average 6.3 on a 9.0 scale for meeting ACO needs. The closest to being exceptions are eClinicalWorks and Epic, who rate 7.0 and 7.3, respectively. eClinicalWorks is the most used across all functional categories, while Epic offers completeness of data in more centralized ACOs.

“With very few exceptions, EMRs are not meeting all ACO needs, causing many third-party products to be invited to the ACO discussion,” said report author Erik Bermudez. “As we look at where healthcare is headed and the rapid growth in the number of physician-led ACOs, we see that this area will only increase in importance.”

In examining the variations of ACOs that exist in the marketplace, KLAS found that independent associations face the most challenges. Without strong governance and a standard EMR, most independent associations rely on third-party tools and claims data, and as a result, are least likely to take on higher-risk contracts. On the other hand, medical groups with centralized management, standardized EMRs, and higher rates of employed physicians take on greater risks associated with Medicare Advantage and commercial health plans.

For more information on the report, visit KLAS online.