If the U.S. is going to get a handle on healthcare spending, providers and healthcare organizations are going to have to get serious about accountable care organizations, says one expert.

This is an era of "heavy-duty strategies and tough decisions," said J.D. Whitlock, director of clinical and business intelligence at Catholic Health Partners at the Healthcare Business Intelligence Forum hosted by HIMSS Media and Healthcare IT News on April 16 in Washington, D.C.

"We've seen the promised land of value-based care," he said, "and we're trying to get there, but right now we're tumbling down the mountain of fee-for-service." 

According to Whitlock, the only way to find success in the current scenario hinges on the ability of hundreds of ACOs to learn very quickly from the organizations that have mastered ACOs -- organizations like Geisinger, the Mayo Clinic and Kaiser.

Whitlock names interoperability as the No. 1 concern these fledgling ACOs share, but that can't be addressed without first addressing an ACO's overall EHR strategy. "EHR strategy and capability drives ACO IT strategy," he said.

Whitlock says ACOs need to ask themselves where they want to invest. "Will you invest in deploying – and subsidizing for affiliates – a centralized EHR capable of at least some population health management? Or are you going to deploy a private HIE capable of clinically integrating many disparate EHRs and a comprehensive population health management platform? You probably aren't going to be able to afford both." 

If you choose to go with a centralized EHR, there are plenty of benefits, Whitlock says, including:

• Reduced effort to bring PHM analytics to point of care;
• Reduced effort to build and deploy new workflows;
• Reduced effort to build a compelling patient portal and effective PHR;
• Reduced effort to collect data for analytics.

But, these benefits are countered with some disadvantages, he says, including:

• Success is possible only by subsidizing EHR costs for affiliates, and obviously this gets expensive;
• Inevitably, some candidate PCP ACO affiliates will desire to remain on their existing EHR;
• Many specialists, by the nature of their practice, cannot commit to a single ACO.

Whitlock says as ACOs develop their analytics teams they should include a healthy mix of junior and senior analysts and those with claims data and clinical expertise. Ideally, it's best to get clinical and claims analytical capability in the same person, but that's hard to find, so organizations might need to grow that dual capability in individuals over time.