How quality programs for providers can be beneficial in an accountable care setting
WagarThere is more collaboration than ever between payers and providers in the drive to provide high-quality, cost-effective care to diverse populations across the United States. According to a January 2014 Centers for Medicare and Medicaid Services (CMS) report, the accountable care organization (ACO) model is starting to live up to its promise. Early results show that it’s possible to manage care in a fee-for-service population. And shared savings are a major incentive.
Physicians have a pivotal role in ensuring patients receive the right care in the right setting at the right cost at the right time. In physician practices where clinical inertia is prevalent, resulting in care that is suboptimal, it’s important to create programs that can overcome it. It’s understood that physicians don’t change their practices easily, so a combination of factors come into play.
Ongoing physician education: Physician education plays an important role in closing the gap between evidence-based medicine and actual practice. There is an opportunity to guide physicians through changes in the delivery of healthcare, like the ACO model. ACO physicians can become comfortable in allowing access to their ACO patients and will deploy value-added utilization and quality programs to patients on their behalf when trust is established.
Reducing ER visits: Recent evidence shows that physician incentives play a big role in managing costly, chronic diseases such as diabetes and congestive heart failure. Providing patients with information is not enough. Active engagement between patient and provider is essential to achieve better health outcomes along with lower costs.
For example, many diabetes patients ask for help with their diet. In a care coaching program, a nurse or wellness coach might call the diabetes patient weekly to provide encouragement, answer questions and help the patient set goals. Data indicates that with care coaching delivered through the Heritage California ACO, beneficiaries see a one to three point improvement in their hemoglobin A1c labs-a key measurement of diabetes.
Using a “whole health” approach: Whole health is about realigning incentives so physicians are encouraged to take care of a patient outside a doctor’s office or a hospital visit. Interdisciplinary teams of primary care physicians, specialist physicians, nurses, pharmacists and other clinicians can provide total care for a patient. Typically, a physician with a fee-for-service patient will only know what happens during a single office visit, but not whether they are adhering to medications or going to the emergency room several times.
Physician incentives for adopting health IT: Technology can improve quality of care while reducing costs. Technology supports both managed care and clinical operations when data is plugged into a health information exchange system. Analytical and decision-making data support physician partners at the point of service in the office when it is beneficiary-specific for both clinical care and quality metrics and is purposely formatted to be prescriptive and actionable. The data should conform with care management programs and alert the treating physician to gaps in care and pre-emptive beneficiary needs.
A path forward: With change, there’s an opportunity to improve the quality of care to thousands of patients within an ACO by working together, coordinating care and controlling costs. Prevention should be applied across the continuum of a person’s entire life from newborn care, through the treatment for serious illness, onward to senior fitness programs and palliative care.
Mark Wagar is president of Heritage Medical Systems, and affiliate of the Heritage Provider Network (HPN), which includes both HPN's Heritage California Pinoeer ACO as well as Shared Savings ACOs.