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Launching a successful accountable care organization is not easy. Here are some tips from David Swieskowski, MD, MBA, president and chief accountable care officer at Mercy ACO.
First, make sure senior leadership is on board. The upfront costs of ACO participation can be high. For example, you may want to consider hiring extra staff to serve as health coaches and therefore improve patient engagement and outcomes. Senior leadership buy-in is absolutely critical from the outset. To this end, presenting a positive ROI can help dramatically.
In the fee-for-service world, ROI comes from increasing medically needed services for chronic disease care, immunizations and cancer screening. But in today’s value-based-reimbursement environment, ROI comes from shared savings. In Mercy ACO’s case, this amounted to some $12 million in reimbursements based on $29.23 million in savings under the Centers for Medicare and Medicaid Services Shared Savings Program.
Chances are that many, if not most, network physicians are already overwhelmed by all the tasks they have to complete and standards they need to meet. Another collective pain point for these physicians consists of all the health information systems and electronic health records that are turning many of them into data entry clerks. Tell your physicians the extra staff that will be added to the ACO (such as health coaches) can take on many of these tasks, including the pre-exam and post-exam questioning and interviewing.
Develop the IT systems to identify, track and create connections in the population you’re most interested in targeting. Build patient registries-either paper-based, Excel-based or electronically based with direct tie-in to billing and the electronic health record systems.
In Mercy’s case, this “infrastructure” consisted largely of the coaching staff the ACO hired to work directly with the patients as well as a training program for the coaches. It also helps to have a data warehouse to capture data and an analytic capability to use the data. Mercy ACO has four data analysts on staff. In addition, there are solutions that support empathic care, such as TAVHealth. The ACO utilizes TAVHealth to further enhance continuity of care through creating connections for patients, families and caregivers to access social, financial and community resources to improve outcomes. This gives patients the tools needed to achieve a healthy recovery beyond discharge.
Patients aren’t just numbers; traditional population health approaches that rely nearly exclusively on hard numbers can fall short of helping managed care organizations to fully achieve lower costs, improved outcomes and a better patient experience. And while devoting additional resources to softer approaches like hiring coaches to help care for patients may seem costly at first, Mercy ACO’s experience shows that the return-on-investment can be great when organizations have the courage to change the care paradigm.
David Swieskowski, MD, MBA, is president and chief accountable care officer at Mercy ACO.