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Few ACOs in their early years made progress on the actual cost drivers in healthcare, including specialty services costs, clinical standards of care, and acute care.
Will accountable care organizations (ACOs) be the value-based payment model of the future?That depends.
As the value-based care market has changed, ACO numbers have dropped and competitive payment models have attracted medical groups. ACOs need to prove that the shared savings model can increase historical savings and retain provider participation. And they may have limited time to do it.
The key to achieving this goal is to advance strategies beyond coordination of care and population health.
Many ACOs today accomplish savings mostly through administrative actions including patient outreach. It’s uncommon for many ACOs to adopt clinically-focused cost strategies. As a result, savings may be suppressed, some studies reveal.Few ACOs in their early years made progress on the actual cost drivers in health care, including specialty services costs, clinical standards of care, and acute care, according to one study. In another, 8% to 21% of ACOs had significant initiatives that impact care.
Let’s examine how ACOs can be the most successful value-based care model. These three strategies help ACOs achieve stronger savings potential.
1. Get the data needed to identify cost drivers and reveal clinical improvements.
The best care coordination fuels patient outreach with clinical and cost data. ACOs relying only on claims data don’t have enough clinical data to support their physicians with the most meaningful cost comparisons: Episodes of care that reveal variations in costs and outcomes. Episodes for patients with diabetes, heart disease, and related metabolic disorders offer a starting point for analyzing associated risk factors and outcomes, and developing specific interventions.
Achieving genuine care coordination requires the integration of data sources. Provider data is rich in clinical information and offers more current data about outcomes and recent patient crises. Cost data with clinical information is essential for physician engagement in cost initiatives. Investing in outside analytics software can enable you to track and evaluate patient episodes, with costs for all services packaged by time and patient. Empower ACOs to identify patients needing treatment review, community services, and changes in care teams. That data will also be necessary as ACOs move to all-payer quality reporting.
2. Optimize specialty care by sharing data and creating collaborative projects between primary and specialty practices.
Both primary care and specialty practices have a stake in an ACO’s success—and neither can do it alone. Creating data sharing arrangements and collaboration on care plans will help ensure that care is rationalized across complex treatments and multiple outcomes. Specialists will respond to reviewing episode data, enabling them see full cost of care for the first time. Both primary care and specialty physicians can examine episodes on a cost curve that reveals potential areas for improvement.
3. Create care plans based on ACO patient population and risks.
Standardizing care for patients with common issues, such as problematic utilization or persistently poor control, will facilitate creation of optimal clinical care teams and patient engagement strategies. This strategy has been effective, for example, at improving outcomes for patients with diabetes and heart disease. Again, to do this right involves tracking episodes of care data, and sharing across providers and health care settings.
Finally, these strategies are imperatives if ACOs are to survive and thrive. Savings is the metric that policymakers associate with ACO success. If ACOs cannot deliver, they will have difficulty inattracting physicians, because of the potential financial cost of failure when there are other options.
It’s up to ACOs to arm themselves with the tools of competitive health systems and other providers accepting risk.While the timeframe for boosting performance is short, their experience over the past several years gives them an excellent starting point for making the next leap in data and physician engagement.
Theresa Hush is CEO and Co-founder of Roji Health Intelligence.