Many hospitals, health systems and physician groups across the country are pursuing accountable care organizations — as of January 2013, there were 428 total ACOs in every state except Delaware. However, the success of these organizations has yet to be determined, and many hospitals and health systems are still deciding if they should enter the ACO space.
Even though there is no perfect formula for ACO success that will work for all organizations,
there are a few important strategies that, if developed properly, are proven to contribute greatly to the success of an ACO. Aegis Health Group highlighted three key ACO readiness strategies in a thought paper, "Accountable Care: The Focus of Reform." Here, Pearson Talbert, Aegis' president and CEO, discusses them further.
While having a solid physician alignment strategy is a step in the right direction, hospitals and health systems on the path to become an ACO need to go beyond alignment to truly integrate physicians into the process. Physicians can offer important input into how to manage patient care across the continuum. "By all means include them in leadership positions and give them a voice," Mr. Talbert urges. He recommends integrating physicians into the executive team and having them be involved in strategic planning during ACO development. "From the start of their medical education physicians are taught to think differently than business people. This perspective must be represented to be effective as an ACO."
Managing the health of a patient population saves money by keeping chronic diseases in check by helping patients avoid expensive hospital or emergency room visits.
One way organizations can prepare for population health management is to begin with their own employee base, according to the Aegis report. There is less risk involved in rolling out new tactics on one's own employee base, and both the employees and the organization benefit: the health of employees improves and the organization can achieve savings through healthcare cost reductions. Additionally, physicians gain experience working on preventive care that can be transferred from the hospital's own employee population to the patient base of an ACO.
Additionally, a developed system can help physicians and administrators develop best practices and report their progress on quality metrics to government or commercial payors, which is part of being in an ACO.
It is important to note that being strong in all three of these areas is important because they work together and feed off of one another, according to Mr. Talbert. For instance, an EMR system helps aligned physicians share information and be on the same page, influencing integration. Data can also help hospitals and health systems effectively manage a population's health by creating database marketing campaigns to proactively reach out to individuals who may not even know they need screenings or a check-up, thus accelerating the care continuum from sick care to healthcare. And when physicians are integrated in the system, they can coordinate better to implement disease prevention, resulting in a healthier population.
Even though there is no perfect formula for ACO success that will work for all organizations,
there are a few important strategies that, if developed properly, are proven to contribute greatly to the success of an ACO. Aegis Health Group highlighted three key ACO readiness strategies in a thought paper, "Accountable Care: The Focus of Reform." Here, Pearson Talbert, Aegis' president and CEO, discusses them further. Physician integration
ACOs need a wide patient base to support the quality and cost-saving measures that come along with accountable care. In order to achieve and then manage a large patient base, it is necessary to have a large number of aligned physicians. "[Patients] don't just come to the hospital of their own free will," says Mr. Talbert. "No one is self-admitting." Organizations looking to form an ACO need supporting, aligned physicians in the community to bring patients into the organization to receive any necessary care.While having a solid physician alignment strategy is a step in the right direction, hospitals and health systems on the path to become an ACO need to go beyond alignment to truly integrate physicians into the process. Physicians can offer important input into how to manage patient care across the continuum. "By all means include them in leadership positions and give them a voice," Mr. Talbert urges. He recommends integrating physicians into the executive team and having them be involved in strategic planning during ACO development. "From the start of their medical education physicians are taught to think differently than business people. This perspective must be represented to be effective as an ACO."
Population health management
Being able to manage the health of a population is the "holy grail" of coordinated care strategies, according to Mr. Talbert. "The organizations that prepare for population health will be prepared for the new payment model," he says, because hospitals and systems that demonstrate cost savings through population health management will get better reimbursements under a pay-for-performance model.Managing the health of a patient population saves money by keeping chronic diseases in check by helping patients avoid expensive hospital or emergency room visits.
One way organizations can prepare for population health management is to begin with their own employee base, according to the Aegis report. There is less risk involved in rolling out new tactics on one's own employee base, and both the employees and the organization benefit: the health of employees improves and the organization can achieve savings through healthcare cost reductions. Additionally, physicians gain experience working on preventive care that can be transferred from the hospital's own employee population to the patient base of an ACO.
Health information technology
Having strong HIT and electronic medical records systems is the backbone of providing coordinated, accountable care. Data ties into every aspect of ACOs, from categorizing high-risk patients to collecting patient data to tracking health improvements. Having a strong HIT system assists with all of these important parts of accountable care.Additionally, a developed system can help physicians and administrators develop best practices and report their progress on quality metrics to government or commercial payors, which is part of being in an ACO.
It is important to note that being strong in all three of these areas is important because they work together and feed off of one another, according to Mr. Talbert. For instance, an EMR system helps aligned physicians share information and be on the same page, influencing integration. Data can also help hospitals and health systems effectively manage a population's health by creating database marketing campaigns to proactively reach out to individuals who may not even know they need screenings or a check-up, thus accelerating the care continuum from sick care to healthcare. And when physicians are integrated in the system, they can coordinate better to implement disease prevention, resulting in a healthier population.
More Articles on ACOs:
19 Questions to Ask on the Road to Accountable Care
ACO Patient Population Attribution: Prospective vs Performance Year Methods
Pioneer ACOs Want CMS to Delay Pay-for-Performance Obligations