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Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, oncology, hospital admissions and readmissions, senior patients, and health policy.
Here are six steps experts say are necessary for success as an accountable care organization (ACO).
From determining the right amount of risk for a provider to absorb to sharing best practices among care navigators, here are six steps experts say are necessary for success as an accountable care organization (ACO).
"You can’t just pass risk to the provider and walk away and hope that they will be successful," says Lisa McDonnel, senior vice president of national network strategy and innovation at United Healthcare. "In order to make providers successful, [we take] the time to determine if providers are really ready to manage patient populations and take on additional risk by means of ... a 'risk readiness assessment.'"
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"Transitioning to value-based models is a long, difficult process," says David Muhlestein, senior director of research and development at Salt Lake City, Utah-based-based Leavitt Partners. "Without an administration that firmly believes in the model and is willing to invest the resources to overcome the inevitable challenges, the organizational transformation will fail."
Stephen Rosenthal, chief operating officer of CMO, The Care Management Company of Montefiore Medical Center, says that patients will typically be with an insurance company for two years, whereas they generally remain with a provider system for life. Thus, provider organizations should invest in wellness programs for their patient population. He cites the examples of smoking cessation and bone density monitoring program, both of which can take more than a decade before you realize the benefits.
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Muhlestein recommends figuring out where the population’s costs are and then dedicating resources to addressing those issues. "There are countless areas that can be improved upon by administrators, but they must prioritize the areas that can show the biggest returns," he advises. "Don’t spread the administrative resources too thin, and don’t spend time addressing areas that either have a low impact or are high cost but not addressable in a reasonable amount of time."
This is a complicated initiative to tackle, says Sandra McAnallan, senior vice president of clinical affairs and quality performance at Pittsburg, Penn-based UPMC Insurance Services Division. "Break down the reasons that someone has to be readmitted. Look at the instructions they get when they’re going home and figure out where there’s room for improvement."
Every quarter, Chicago, Ill.-based Health Care Service Corporation brings together its nurse care managers, who are hired by physician practices and paid for by the payer, for training and to share their successes and "war stories," says Steve Hamman, senior vice president for enterprise network solutions and provider partnerships. This gives care navigators an opportunity to share among themselves how they deal with patients who present with multiple chronic diseases, mental health, and substance abuse issues, among other topics in a noncompetitive setting, he says.
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