Value-based Financial Services and Software Investments Advancing Maturation for Large Accountable Care Organizations; Small ACOs Lag Far Behind, Finds Black Book Survey

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Anticipating an adverse impact on profitability with the transition to value-based care, ACOs are focused on financial solutions. Black Book™ has produced a series of three ACO infrastructure surveys: Financial Services and Software, Clinical Integration and Support, and Business Intelligence and Analytics; and the first data set was released today.


93 percent of ACOs, hospitals and physicians report they struggle to determine the impact of how much risk they have already assumed. At the same time they are stumbling on how much they are still willing to assume,

Financial solutions are among the highest infrastructure priorities as identified by 97 percent of ACO executives, in a recently published Black Book™ survey of over 600 ACOs. However, only 12 percent of operational ACOs and 6 percent of hospitals and physician groups sitting on the ACO sidelines believe they have the adequate installation of financial technology, outsourced services and consulting to be successful in the long term.

78 percent of CFOs confirm they are caught between revenue management services that fast-track the inflow of cash to sustain present fee-for-service reimbursement, and selecting ACO strategic solutions to assemble the groundwork to succeed with imminent risk-bearing payment models.

“Large ACO’s have the capital and provider base to strategically select vendors who can deliver end-to-end financial services and software now, ahead of tackling population health, clinical integration and business intelligence tools into the technology amalgam,” said Doug Brown, President of Black Book.

Black Book received 106 responses from the nearly 400 Medicare accountable care organizations at the time of the Q2 survey. Additionally, 718 commercial or combination Medicare/Commercial ACO staffers completed financial services and software evaluations from 840 various hospital and physician groups.

Electronic health records vendors are not currently meeting the financial and risk management needs of most (91 percent) ACOs, according to the poll on organizational technology assessments.

92% percent of CIOs, in a previous Black Book survey conducted in Q3 of 2013, found that their EHR system did not offer the functionality for ACO start up. However in 2014, some EHR vendors outranked several third-party vendors, in the user satisfaction scores.

95 percent of small ACOs, as well as 93 percent of hospital organizations late to form value-based care strategies, confirmed that problems with claims data, unstructured governance models, physician recruitment and EHR replacements are stopping motions towards taking on higher-risk contracts.

67 percent of newly-forming ACOs admit to having too limited capital to ramp up financial operations and technology fast enough to become eligible or competitive in value-based care in 2015.

Black Book measured the user satisfaction of value-based care financial services and software vendors on 18 key performance indicators, and in four functional areas of end-to-end ACO financial solutions.

86 percent of all hospital CFOs and 90 percent of ACO executives agree that without a strong financial solutions vendor to provide value-based reimbursement software, outsourced services and support, and consulting, they will be forced to opt out of many key risk-based contract opportunities.

“Payers and employers are demanding providers to assume greater levels of financial risk for managing the care they deliver to their covered populations, but most hospitals and physician groups don’t have the latest staff or technology competencies to be competitive,” said Brown.

93 percent of ACOs, hospitals and physicians report they struggle to determine the impact of how much risk they have already assumed. “At the same time they are stumbling on how much they are still willing to assume,” said Brown.

Ranking first in the survey of value-based financial services outsourcing, consulting and software is Frisco, Texas based Conifer Health Solutions. “With more than 20 years of experience helping hundreds of clients navigate the journey to value-based care, Conifer Health has helped both Medicare and commercial accountable care organizations in becoming full risk-bearing organizations,” noted Brown of the top performing firm.

Other top ranked third-party firms and consultants named in the Black Book report “Top Twenty ACO/Value-Based Care Financial Services and Software Vendors” in 2014 are: The Advisory Board, Phytel, Optum, Medecision, Health Catalyst, RelayHealth, Aetna Medicity, Cerecons, Sandlot and MedVentive.

Top ranking EHR-centric ACO solutions included Allscripts, Cerner, NextGen and Epic Systems.

About Black Book™
Black Book Rankings, a division of Black Book Market Research LLC, provides healthcare IT users, media, investors, analysts, quality minded vendors, and prospective software system buyers, pharmaceutical manufacturers, and other interested sectors of the financial and clinical technology industries with comprehensive comparison data of the industry's top respected and competitively performing technology, services and outsourcing vendors.

The largest user opinion poll of its kind in healthcare IT, Black Book™ collects over 400,000 viewpoints on information technology and outsourced services vendor performance annually. For methodology, auditing, resources, comprehensive research and ranking data see

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Douglas Brown
Black Book (TM)
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