What Makes Some ACOs More Successful at eCQM Reporting Than Others?

Some Accountable Care Organizations (ACOs) are excelling at eCQM reporting while others struggle to keep up. The difference often comes down to a few critical factors that separate high performers from those barely scraping by.

With the CMS Web Interface officially closed as of March 31, 2025, there’s no more room for delay. Understanding what makes some ACOs successful can help others catch up.

Key Takeaways

Data aggregation across multiple EHR systems is the biggest challenge ACOs face with eCQM reporting.
Successful ACOs invest early in technical infrastructure and experienced vendor partnerships.
Clinician engagement requires workflow optimization and clear communication about why changes matter.
ACOs that started their transition in 2023 or 2024 have a significant advantage over late adopters.
The reporting population often expands dramatically throughout the year, catching unprepared ACOs off guard.

The Data Aggregation Challenge

Most ACOs in healthcare aren’t dealing with a single, unified EHR system. A 2022 survey found that more than three-fourths of ACOs have at least six different EHR systems. Some large organizations work with 16 or more EHR vendors.

This creates a massive technical challenge. Each EHR captures data differently, uses different coding standards, and requires different processes to generate the QRDA-I files needed for eCQM reporting. Aggregating all that data, normalizing it, deduplicating patient records, and ensuring accuracy is the make-or-break factor for success.

The ACOs that excel have invested in robust data aggregation platforms early. They’ve partnered with vendors who can pull clinical data from every EHR in their network and create a unified patient record. They’ve also developed enterprise master patient indexes (EMPIs) to ensure each patient has a unique identifier across all systems.

Common pitfalls include: manual file collection processes that create delays, missing data from poorly optimized EHR workflows, patient matching errors, technical expertise gaps in smaller practices, and unexpected vendor fees for generating QRDA-I files.

One large ACO that started eCQM reporting in 2020 noted that early preparation was “financially beneficial while also giving us time to expand reporting and continually improve our process.”

Why Timing Matters

The ACOs succeeding at eCQM reporting share one thing in common: they started early.

Organizations that began their transition in 2023 or 2024 had time to test systems, identify problems, and fix them before stakes got higher. They used optional reporting periods to iron out technical issues without the pressure of mandatory compliance.

Starting early gave these ACOs critical advantages. They tested data aggregation across all practices and identified which EHR systems had problems. They trained clinicians when there was still time to adjust workflows. They analyzed performance on the three required measures (diabetes control, depression screening, and hypertension) across their entire patient population.

ACOs that delayed are now discovering problems at the worst time. They’re realizing their reporting population is much larger than expected. They’re finding that some practices can’t generate required files. They’re scrambling to train clinicians while meeting data completeness requirements, and the measure requirements have in increased from 3 measures at inception, to 5 required measures for 2026.

The financial stakes are high. An ACO that fails to submit eCQMs effectively must revert to either CQM or MCQM reporting which could mean lower performance and scores, directly impacting shared savings and triggering CMS review.

healthcare professionals having a team meeting

Getting Clinicians Engaged

Technical infrastructure matters, but it’s worthless if clinicians won’t use it properly.

Successful ACOs understand that electronic quality reporting requires significant behavior change from already stretched providers. The best approach combines clear communication with workflow optimization.

Clinicians need to understand why these changes matter, not just how to comply. When they see how eCQM data can improve patient care and identify treatment gaps, engagement improves dramatically.

Workflow optimization is critical. Successful ACOs redesign their EHR workflows to make documentation as easy as possible. They reduce unnecessary clicks, implement smart templates, and integrate quality measure capture into the natural flow of patient care.

Three Strategies That Work

Focus Training on Primary Care First

The five required measures are typically documented in primary care settings. Concentrating initial training efforts on primary care providers creates the biggest impact with the least resource drain.

Use Real-Time Performance Dashboards

Clinicians respond well to timely, actionable data. Real-time dashboards showing performance on quality metrics for ACOs help providers identify improvement opportunities before it’s too late.

Assign Clear Roles

Not every provider needs to document every measure. Identifying which providers are best suited for specific screenings reduces burden and improves data quality.

The Volume Problem

Here’s what catches many ACOs off guard: the reporting population is much larger than expected.

Under the old CMS Web Interface, ACOs reported on 248 patients from a sample of 616 Medicare beneficiaries per measure. Now they’re reporting on 100% of all patients who meet criteria, regardless of payer, and of those eligible patients, at least 75% must have a numerator (performance quality action.)

This shift is massive. A mid-sized ACO with 60,000 attributed members might report on more than 120,000 Medicare beneficiaries.

The patient lists also expand throughout the year:

Q1 quarterly files often look manageable
By Q3, most ACOs see a majority of their final reporting volume
Q4 brings remaining patients, often the most complex cases

ACOs that understand this pattern plan accordingly with appropriate staffing and scalable processes.

Choosing the Right Technology Partner

Selecting the right vendor makes an enormous difference.

Successful ACOs look for integrated solutions rather than cobbling together multiple systems. The best vendors support electronic clinical quality data collection across multiple EHR systems regardless of vendor. They normalize and validate data before submission. They provide real-time analytics for tracking progress throughout the year.

Technical requirements matter too. ACOs need to verify every practice can generate QRDA-I files, especially those using less common EHR systems. All practices need Certified EHR Technology (CEHRT) meeting ONC’s certification criteria.

team of healthcare professionals meeting

Understanding the Financial Impact

Understanding the cost-effectiveness of ACOs requires looking at both costs and benefits.

The financial burden comes from three sources:

Infrastructure upgrades for integrating data across multiple EHRs
Ongoing technical support and vendor relationships
Time clinicians spend on documentation and training

However, successful eCQM reporting creates benefits that offset these costs. CMS offers incentives for eCQM adoption, including a complex organization adjustment adding one measure achievement point per submitted eCQM (up to 10% of total points).

More importantly, comprehensive quality data reporting to CMS directly impacts an ACO’s ability to maximize shared savings. To get maximum savings, ACOs must meet or exceed their minimum savings rate AND achieve the quality performance standard.

The math is straightforward: investing in proper infrastructure protects shared savings revenue and improves MIPS payment adjustments. ACOs that skimp on these investments risk losing far more in penalties than they save on technology costs.

What High Performers Do Differently

When you look at ACOs that consistently perform well, certain patterns emerge.

They treat quality reporting as a year-round priority, not a last-minute scramble. They invest in data infrastructure early and choose vendors with proven track records. They engage clinicians through both relationship-based and metrics-based strategies.

High-performing ACOs distribute financial incentives strategically. Most distribute at least 50% of shared savings to participating practices. Some link payments to quality performance, creating direct financial motivation for proper documentation.

They implement continuous quality improvement processes rather than waiting for annual results. With real-time dashboards and regular reviews, they identify problems early and adjust workflows throughout the year.

Perhaps most importantly, successful ACOs view eCQM reporting as part of a larger strategy to improve care coordination and patient outcomes, not just a compliance exercise.

Ready to optimize your ACO’s eCQM reporting strategy and maximize your shared savings potential? The difference between struggling with compliance and excelling comes down to having the right infrastructure, processes, and support in place.

Moving Forward

The ACOs that excel at eCQM reporting aren’t doing anything magical. They’re investing in proper infrastructure, engaging clinicians effectively, planning for realistic volumes, and starting early enough to work through problems.

With mandatory eCQM reporting now in effect and the CMS Web Interface permanently closed, there’s no more room for delay. The ACOs that succeed will be those that treat quality reporting as a strategic priority with adequate resources and thoughtful implementation.