6 Successful Strategies to Supercharge your ACO

The true key to achieving high savings, more patient volume, and better health outcomes is to effectively use clinical and cost data with physicians to create interventions that improve performance.

What makes an accountable care organization (ACO) successful? While there have been many studies trying to figure out the secret, most are incomplete because they’re more focused on organizational attributes.

The true key to achieving high savings, more patient volume, and better health outcomes is to effectively use clinical and cost data with physicians to create interventions that improve performance.

While ACO’s need plug-and-play tools for their specific systems, physician networks, and competitive ingredients, none of that will matter if the essentials are not in place. So let’s explore the six secrets to ACO success.

1. Lead with a vision of value-based clinical care.

Design your ACO leadership venture for clinical excellence with a value-based emphasis and with collaboration of clinicians. Unlike historically volume-based goals, ACOs with a value-based vision involve clinical leaders and clinicians to identify and implement best clinical practices through data. Clinically-focused value will help you develop cost interventions that go beyond administrative activities and establish standards of patient care that are transformative and worthy of physicians and patients.

2. Build an effective data infrastructure with robust clinical and cost data.

ACOs need comprehensive and detailed data to conduct macroanalysis on costs and microanalysis on costs and quality. This means that your ACO should be collecting patient-identified clinical data, data on social determinants of health, and prescribing data from provider systems to integrate with claims data. Your ability to control exacerbations (and resulting high costs)in patients with chronic disease depends on your ability to first identify patients with persistently poor control of their conditions, and compare their outcomes, costs, and treatment modalities. These analyses will lead you to establish best practices, and interventions to get patients on the correct pathway to improvement.

A technical infrastructure that provides for safe and secure patient data is essential. You can build it, buy it, or do some combination - but security is key. HIPAA-compliance is a baseline requirement for all systems, but it’s not a substitute for an effective data architecture. Unless you’re an organization with a large budget, the smartest choice is likely working with an outside vendor. The good news is that you can purchase affordable secure technology infrastructure services even on a small budget. Look for companies that facilitate access to patient records across providers as well as solid applications for using your data, including analytics, patient episodes of care (or another cost engine), quality measurement, and population health.

3. Target initiatives to reduce costs and improve outcomes, based on episodes of care data for key conditions and procedures. Patient episodes of care include all the services that are related to the diagnoses within a defined period of time. Done right, this approach will enable your ACO to compare costs across all patients within a single condition or procedure, revealing patients whose costs exceeded norms, and the factors involved. With the involvement of physicians, ACOs can turn clinical episodes that reveal problematic outcomes, exacerbations and complications into tailored population health initiatives and clinical pathways that “reset” the ACO path toward value.

4. Foster physician-focused collaboration.

Physician-focused collaborations and improvements are a must for supercharging your physician buy-in.
Most physicians say that they don’t get good or actionable cost data from their organizations. The best ACOs actively involve physicians in investigations around cost drivers, data sharing, coaching, and improvement activities. For example, do your physicians have routine access to ACO analytics? Are they involved in clinical intervention developments as a result of episode-revealing analytics?

5. Apply effective quality and evidence-based measurement.

Quality measurement and quality reporting should be two very different activities, and your emphasis should be mostly on the former. Quality measurement should be a process for your ACO to generate patient improvement in outcomes and cost over time. Because it is dynamic and continuing, measuring quality and cost together through episodes will reveal opportunities that boost savings. Quality measurement should flow immediately into interventions and improvement activities.

Quality reporting, on the other hand, is a regulatory requirement. It involves a set of static quality measures that are reviewed once per year for a sample of patients. The measures fall short of helping you target best practices, beyond closing gaps in care.

Your ACO will achieve success if you measure improvement of patients over time, acknowledge providers who have adopted best practices, and implement clinical and administrative interventions that result in improved outcomes for patients.

6. Create a multidimensional improvement program.

Successful ACOs tackle the largest issues impacting costs, which requires understanding those costs at a granular level.
You can achieve this by implementing an effective multidimensional improvement program that identifies and prioritizes at-risk patients in various populations based on patient risk factors, conditions, and outcomes. Take behavioral health, for example. Are your clinicians involved in integrated primary/behavioral health initiatives? Do you have formal referral arrangements with external or community resources? Do you provide or arrange for patient programs for education and risk prevention or management?

You can supercharge your ACO.

ACOs are in competition with other value-based payment models - Medicare Advantage Plans, physician organizations backed by equity, large hospital-based systems. That competition affects the long term sustainability of all ACOs to attract physicians and patients. It’s not enough for you to just keep doing what you’ve been doing and hold down costs without sacrificing your physician network and patient health outcomes. Your ACO might chug along for a little while, but it will eventually crash. So implement these six strategies and supercharge your ACO today to create value for your organization and your patients.

Theresa Hush is CEO and co-founder of Roji Health Intelligence. Hush is also a healthcare strategist and change expert with experience across the healthcare spectrum, including public, non-profit and private sectors.