Pioneer ACOs act on lessons learned

Much like the early American settlers, Pioneer Accountable Care Organizations (ACOs) are blazing a trail. 

WagarWe learned three key things in the first year of the Pioneer ACO program.

• Patient engagement is and continues to be critical. A patient’s picture of health is not just a sum of the current function of their body parts. It’s also the world in which they live, the network of family and friends they have for support, and the life situations and challenges that may present barriers to complying with healthy behaviors.

The coordination of care provided to patients must bring these factors into account, and continue to serve patients far beyond the walls of a hospital or doctor’s office. Something as simple as a missed doctor appointment can turn into an emergency room visit, which becomes a hospital admission and skilled nursing facility stay. In the current dominant fee for service system, despite everyone’s best-but all too fragmented- efforts, patients can often have a higher likelihood of never getting back the health status and lower cost that could have been achieved if we found a way to help them keep the appointment.  

Establishing a coordinated network of care delivery around individual patients and promoting ongoing patient engagement can help prevent this type of vicious cycle from taking shape. This will be the ultimate test for ACOs. It is the key to ensuring ongoing treatment compliance among ACO patient populations and performing well-timed health interventions if needed. 

• For an ACO to succeed, buy-in from the providers is critical. You need to help doctors understand why this is not just another government mandate, and how their practice maps to the overall goal of your ACO. Over-communication should be the goal. The more communication you can have with your providers, and the more specific you can be with data and guidance to meet performance benchmarks, the better.

But more than that, a successful ACO will effectively communicate why participation is not only an opportunity for providers to improve the care they deliver, but also be rewarded financially by the government not just for visits and procedures, but for succeeding in being more proactive and integrated.

• Asking tough questions at the outset can avoid large headaches down the road. If you are considering forming an ACO, consider whether your organization is financially and structurally prepared to take on an ACO model? You need to ensure that you have the wherewithal to adopt an ACO model, which can be a significant departure for most organizations.

It is important to remember that your organization is not compensated unless you can meet the performance benchmarks. It may be a while until you begin seeing a financial reward for participating in accountable care-can you weather the storm and continue to self-fund your ACO?

Another important question is how integrated your organization is. Do you have a delivery system capable of coordinating performance-based care among a large network of traditional healthcare providers, community organizations, family units, and other influencers in the patient’s environment?   Are you willing to measure and move quality and cost performance? That kind of commitment not only calls for strong technology integration but is also a cultural issue. Are your providers ready to shift from deeply ingrained care practices toward a more proactive posture?

Lasting change will not happen overnight. After year one, the earliest Pioneers are acting on lessons learned, adjusting their course, and trying new strategies that will likely be adapted over time. ACOs are directionally on the right track and can accelerate the needed changes in healthcare delivery.   

Mark Wagar is president of Heritage Medical Systems, an affiliate of the Heritage Provider Network (HPN), which includes both HPN’s Heritage California Pioneer ACO as well as Shared Saving ACOs.