What are the foundational requirements that create momentum to clinical, operational and financial performance for an accountable care organization?
There are six foundation requirements, which include:
- Agreement on goals
- Patient-centered medical home certification
- Meaningful use-certified electronic medical record
- Engage entire continuum of care
- Agreement on practice standards
- Commitment to active care coordination
1. Agreement on goals
All parties within the ACO must agree to the following:
- Adoption of Medicare Shared Savings Program metrics, including:
- Cost
- Quality
- Compliance
- ACO enterprise performance metrics, including:
- Business operations
- Clinical performance
- Cost management
- Productivity
- Growth
2. PCMH certification
PCMH certification is critical to ACO successes for the following reasons:
- PCMH demonstrates primary care provider commitment to triple aim goals
- Ensures focused attention on aspects of primary care that improve quality and reduce cost
- Enhances team-based approaches to Care
- PCMH practices have already begun the culture change needed for success in value-based care
3. Require meaningful use-certified EMRs
EHRs are foundational to ACO success for the following reasons:
- EMR data is critical to ACO performance
- Qualifying for MU incentives is an MSSP quality metric
- Core Objectives for meaningful use align with ACO quality metrics, including:
- Reporting ambulatory clinical quality measures to CMS
- Generating lists of patients by specific conditions
- Providing a summary care record for each transition of care or referral
4. Engage entire continuum of care
Successful ACOs coordinate care for patients across the following sites of care:
- Acute care
- Ambulatory care
- Post-acute home care
- Post-acute skilled nursing care
5. Agreement on practice standards
ACO participants must agree to practice standards, including:
- •Clinical work groups to set coordination pathways
- Initial focus on conditions used for quality metrics
- Diabetes
- COPD/Asthma
- Congestive heart failure
- CAD/Hypertension/Ischemic Vascular Disease
- Depression
- Preventive health
- NQF Metrics, primarily outcomes
- A common coordination plan across the ACO
6. Commitment to active care coordination
Care coordination is a major opportunity for improving costs, quality and satisfaction, as illustrated on the graph below.
Source: Identifying and Quantifying the Cost of Uncoordinated Care: Opportunities for Savings and Improved Outcomes, Mary Kay Owens, R.Ph.,C.Ph, Institute of Medicine, 2009.
Care coordination within ACOs should include:
- Patient navigators, who serve as care coordinators in hospital and practices
- Integrated in clinician workflow
- The sharing of care coordination plans, care coordination tasks and secure messages in a standardized format
- Proactive preventive, acute, chronic and end of life care
- A common language for care coordination lifecycle status
- Proactive (not claims) data to drive coordination efforts
I have been following the development of ACOs since 2009, when many people wrote off ACOs as unicorns. Now, the unicorns are here to stay, and they are multiplying. I believe we will see more demonstrable change in the way that healthcare is delivered, managed and paid for in the next five years, than we have seen in the past 20 years.
Alan Gilbert is a mission-driven growth serial entrepreneur with “up through the ranks” experience in the healthcare industry. He is viewed as a thought leader in the areas of accountable care solutions and collaborative care, is a frequent contributor to professional online journals as well as a sought after speaker at industry conferences. Mr. Gilbert is currently the Chief Growth Officer and Co-Founder of TEAM of Care Solutions, LLC, focusing on Technology Enabled Active Management of Care (TEAM).