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As ACOs continue to grow in the healthcare sector, it is imperative that a liaison is in place to act as an intermediary between ACO members and patients to help achieve desired outcomes.
The future of healthcare relies on open communication and patient-centric practices to provide quality care, which is the core concept behind accountable care organizations (ACOs). ACOs are groups of doctors, hospitals, insurers and other healthcare providers who voluntarily come together to provide high quality care to patients.
The goal of coordinated care efforts is to ensure patients receive the right care at the right time, while organizations avoid unnecessary measures and allocate resources efficiently and effectively. Simply put, these organizations have a “share in the savings and benefits” approach to healthcare.
Ideally, ACOs will include all invested parties ranging from frontline healthcare providers to medical device suppliers, so the groups can address each aspect of the healthcare process from a patient’s initial check-in and diagnosis to providing a subscription and using medical devices for recovery.
Even with an ACO, achieving a streamlined process for patient care can be a difficult undertaking since ACOs are voluntary organizations. Furthermore, once achieved, ACOs often need a representative to bridge the gap between the organized members and the patients they serve.
The ACO liaison role is similar to a business/IT account manager role. This position helps establish strategic initiatives supporting identified objectives, facilitating program planning, setting expectations and improving overall results. ACO liaison positons can be grouped into three models: communicator, facilitator and planner.
First and foremost, this type of ACO Liaison should be relationship focused. The Communicator Liaison must be skilled at building and maintaining relationships with an acute awareness of the objectives within the ACO participants. Because of inherent conflicts in the provider/payer relationship, a Communicator Liaison must also be a skilled negotiator.
This liaison role emphasizes the necessary in-depth knowledge and understanding of the ACO organizations, as well as their business divisions, plans and priorities. In order to effectively share information with the ACO participants and patients so everyone understands the process, a Facilitator Liaison must be able to streamline healthcare interactions, such as supplying dwindling medical devices or coordinating health insurance payments for regular visits.
A Planner Liaison must assist with the prioritization and alignment of initiatives related to the ACO business strategies. As the intermediary between payer and provider, Planner Liaisons require essential knowledge and insight into how their ACO operates and what improvements can be made to optimize operations to improve patient care.
The liaison models are not mutually exclusive, but each can be more effective than the others depending on an organization’s culture and maturity. Since organizations change over time, the model and relevant Liaison skills must also evolve to remain effective.
A few factors to consider that could affect the ACO’s necessary skillset include stakeholder and executive involvement, decision making empowerment and ability to deploy enterprise-level experience systems for patients. Each model has benefits, but an ACO liaison’s effectiveness as a go-between for patients and invested organizations can depend on the specific issues the liaison is meant to analyze and solve.
While being relationship-focused and up-to-date on healthcare trends are both vital to being a successful liaison, there five additional key skills for the position.
1. Knowledge of ACO quality measures
Liaisons must know the ins and outs of ACOs in order to capitalize on efficiencies and potentially to receive lucrative reimbursements. Staying informed and on-top of new developments in measurement can provide potential savings for invested organizations and patients alike.
2. Knowledge of provider and payer
Understanding the benefits of an ACO is only a portion of what Liaisons need to know. The other major component is knowing how the organizations within the ACO operate. Claim submissions, explanation of benefits and explanation of payments remittances, benefit inquiries and procedure authorizations are all business operations that liaisons need to leverage to streamline payment and healthcare practices. The liaison must also know these processes in a traditional fee-for-service model, and how they differ from the ACO model.
3. Ability to measure the value of improving business processes
The current healthcare system has inefficiencies, so the Liaison must always be vigilant of ways to reorganize or create new processes that save money. The liaison must also advocate the clinical and administrative process documentation for providing care, both episodic and bundled, to understand the true costs and how they can be reduced by improving the overall process.
Patients of an ACO will be apprehensive of changes in an already complex healthcare system. The liaison must cultivate and maintain patient collaboration with the organizations in the ACO. Liaisons must support a patient-centric experience before, during and following healthcare treatment, which includes payer-provider relations. For clinicians, the awareness must go beyond the episode, surgery or encounter. Transparent STARS scores, quantifiable changes, even clinician experiences at the facility should be documented and analyzed for improvement. An ideal background for a successful liaison is having previously served on the provider side as part of a multi-plan network or from the payer side having built provider networks.
5. Compassionate advocate for patient health
Quality patient care is the ultimate goal of ACOs. An effective liaison will walk a mile in the shoes of the doctor, nurse, care manager, customer service rep and the patient. Then, they will prioritize with empathy to dramatically improve overall experiences. Patients, members and employers who feel like someone cares will demonstrate a higher tolerance for change if and when it occurs.
In order to achieve an ACO arrangement that achieves desired outcomes, such as lower readmissions, shared coordination of care, lower cost of care, higher patient satisfaction and healthier lifestyles, an ACO liaison must be the force behind proactive change. Changes to the healthcare process will not be easy, but with an experienced individual in place with the proper knowledge, skills and passion, progress will not be as challenging.
Adam Nelson leads the Healthcare and Life Sciences Solution Offerings group at NTT DATA Americas. The group's focus is productizing service capabilities to bring predictable and relevant industry solutions and benefits to its clients.
John Turnure serves as a director in the Healthcare & Life Sciences Business Consulting unit. Turnure is also a governance, risk and compliance specialist with extensive knowledge of HIPAA, healthcare reform, meaningful use and other healthcare mandates.