BLOG: How providers can ensure success in ACOs

Moving toward Accountable Care Organizations (ACO) is not a “flash in the pan” movement. Although experimental in some groups, ACOs are proven in others, representing a viable, less complex model to move healthcare forward.

Jeffrey S. Rose, MDThe early efforts must be distinguished from the full-fledged goals of accountable care: to provide improved health status and disease treatment outcomes globally at the lowest cost, with shared stakeholder risk for expense and quality of care. Clinical workflow integration for caregivers, partnerships with payers and solution providers, stakeholder clinical content and decision support, processes to support fee-for-value payment models, and analytics are all major considerations of this model.

This was even more apparent in my discussions and observations during the Fourth National Accountable Care Congress in November, which emphasized an ACO’s role in supporting better outcomes and quality, as well as the accountability for action among all parties.

While many providers appear to be well positioned to participate in an ACO, they need to have access to the right financial and clinical information and technology to be successful. There are a several questions providers should ask themselves:

• Will the information I receive from these patients be sufficient for me to take on and manage this risk?

• How effective do I think I can be (given my office workflow) in documenting and submitting the information I receive so that I am not at risk of losing revenue?

• What additional work is required to collect, aggregate or act upon the performance measures needed to determine how at-risk funds should be distributed?

Information exchange between providers and payers delivers the most comprehensive view of what has happened to a patient across health systems. Combining claims data with clinical information gives providers most of the information they need to make decisions to successfully meet their selected ACO measures. The best technology solutions will deliver these insights conveniently within existing workflows. Simply providing ‘more data’ does not equal more information; these solutions must deliver data insights in a friendly, actionable way at the time of service or clinical encounter.

The requirements to move from volume-based to value- based healthcare will not be easy, but we are on the path, which is good for the country, good for patients, and ultimately, good for providers. I believe sharing of information between payers and providers will be the single most important element to achieving ACO success.