ACO Performance depends on seeing patient data when it matters, not months after care delivery. Most ACOs operate with systems that don't communicate, creating gaps that result in missed shared savings opportunities. Your EHR doesn't talk to your claims platform. Your care management tool uses different risk scores than your analytics dashboard. By the time data aligns, intervention windows have closed.

Many ACOs operate with 60–90 day claims lags due to disconnected systems, while high-risk patients spiral toward costly hospitalizations. Risk scores misalign across systems. Attribution shifts without warning. Manual forecasting misses CMS actuals by millions. These are structural challenges that prevent care teams from identifying and acting on rising costs early enough to capture savings.

What Interoperability Means for ACOs
Interoperability is the ability of different healthcare systems to exchange and use patient data in a consistent, reliable manner with minimal manual intervention. It's not about having data, it's about having usable data when care managers need it.

Healthcare operates on three interoperability levels. Foundational interoperability lets systems exchange data, but receiving systems can't interpret it. Structural interoperability defines data fields so systems understand what they receive. Semantic interoperability enables systems to interpret and use data for clinical decision support without extensive human translation. Most ACOs remain stuck at the foundational level, receiving data they can't act on without manual processing.

How Interoperability Gaps Destroy ACO Performance
Disconnected systems create four structural barriers that reduce shared savings opportunities before care teams can intervene. These challenges directly impact ACO performance in 2026 as value-based contracts demand faster, more accurate responses to patient needs.

Claims Data Arrives 60-90 Days Late
Claims reach ACOs two to three months after care is delivered. A diabetic patient with three ER visits last quarter may already have two more this quarter before the pattern becomes visible. You're identifying historical problems using delayed data while today's costs keep climbing.

The financial impact: High-risk patients needing immediate intervention don't appear on care manager dashboards until after preventable hospitalizations occur. A patient heading toward a high-cost admission often generates no actionable alerts until after discharge.

Risk Scores Don't Match Across Systems
Diagnosis data captured in EHRs often differ from the data used by claims-based HCC models. Care management platforms use incomplete diagnosis data for risk stratification. CMS applies its own risk adjustment methodology, which frequently differs from the internal risk models used by ACOs.

Care managers end up prioritizing moderate-risk patients while truly high-risk individuals with fragmented data profiles slip through unnoticed. Resources flow to the wrong patients because no single system holds the complete picture.

Attribution Changes Without Warning
Patient attribution shifts quarterly based on claims patterns that ACOs can't track in real time. You invest care management resources in a complex patient who gets attributed to another ACO next quarter. Or you inherit a high-cost patient mid-year with zero context on their care history or current needs.

Disconnected systems often fail to flag these changes until CMS reports arrive, limiting proactive attribution management.

High-Cost Patterns Stay Hidden
Without connected systems, utilization patterns scatter across multiple platforms. A patient seeing specialists at three health systems, filling prescriptions at different pharmacies, and visiting various ERs creates data trails that no single system captures.

What gets missed:

● Duplicate testing across unconnected facilities
● Conflicting medications from multiple prescribers
● Unnecessary procedures due to incomplete records
● Preventable readmissions that fragmented data can't predict

How Interoperability-Related Operational Barriers Slow Care Teams Down
Even when ACOs identify problems, disconnected tools prevent timely action. These operational challenges compound structural barriers, further limiting ACO performance.
Teams Navigate 10+ Fragmented Systems.

Care managers toggle between EHR, claims platform, care management system, analytics dashboard, risk adjustment tool, and quality reporting system daily. Each requires separate login credentials, displays data differently, and updates on different schedules.

The workflow reality: Check claims for recent utilization. Switch to EHR for clinical notes. Open care management platform to update care plans. Jump to analytics for quality measures. Return to the claims system because it timed out.

Result: Operational assessments suggest that a significant portion of care manager time, sometimes approaching one-third, is consumed by system navigation.

Manual Forecasting Misses Financial Targets
ACOs build projections using spreadsheets that manually pull data from multiple sources. Finance teams estimate shared savings with incomplete claims data, outdated attribution lists, and risk scores that don't match CMS methodology.

Manual forecasts often miss CMS actuals, sometimes by millions of dollars, due to incomplete and delayed data.

Intervention Windows Close Before Action Happens
A high-risk patient misses a cardiology appointment. The specialist's EHR notes the no-show. Three weeks later, the claims data shows the missed visit. Two weeks after that, a care manager sees the alert. By then, the patient had visited the ER twice and been admitted once.

Disconnected systems eliminate prevention opportunities through delays that make intervention impossible.

How ACOs Can Overcome Interoperability Barriers
Solving interoperability requires moving from fragmented point solutions to unified platforms that aggregate and normalize data in real time. ACO performance barriers dissolve when systems connect, and data becomes actionable.

Implement Real-Time Data Aggregation
Connect claims feeds, EHR systems, ADT alerts, lab results, and pharmacy data into a single digital health platform. Real-time aggregation means care managers see utilization as it happens.

A patient visits the ER at 2 AM. By 8 AM, their care manager has an alert with clinical context, recent utilization history, and current care plan all in one view. That's the difference between reactive and proactive care management.

Standardize Risk Stratification Across Systems
Use AI-driven models that combine clinical data, claims history, social determinants, and utilization patterns to create unified risk scores. Stop relying on fragmented HCC calculations that vary by system.

Care managers work from the same priority list regardless of the tool. Resources flow to truly high-risk patients based on comprehensive data. Risk scores align more closely with CMS methodology, improving forecast accuracy.

Track Attribution Proactively
Monitor patient-provider relationships in real time to predict attribution changes before they happen. Flag patients whose visit patterns suggest they might shift to another ACO next quarter.

This allows care teams to adjust strategies for patients likely to remain attributed while avoiding resource investment in patients showing attribution signals toward other organizations.

Unify Workflows in a Single Platform
Eliminate system-hopping by bringing care management, analytics, quality reporting, and provider engagement into one environment. Care managers document interventions, check quality gaps, review utilization, and communicate with providers without changing platforms.

Productivity gains: Care managers spend 30-40% more time on direct patient care when they're not constantly switching systems and re-entering data.

Wrap Up
ACO performance barriers aren't inevitable. They result from technology decisions that prioritized individual point solutions over integrated systems. Top-performing ACOs recognize that shared savings require unified platforms, eliminating blind spots and enabling real-time action.

Persivia helps ACOs address interoperability challenges by enabling real-time data aggregation, consistent risk assessment, and more proactive care coordination. By reducing data latency and system fragmentation, Persivia supports earlier intervention, better forecasting, and stronger shared savings performance.