Don’t Limit Your ACO’s Success: 5 Rules for Making the Most of Your ACO

July 29, 2016 Suzanne Cogan, Vice President, Healthier Populations Sales

I’ve met with many leaders in accountable care organizations (ACOs), and I’ve sensed a lot of anxiety around the reimbursement initiatives of the Medicare Shared Savings Program (MSSP) and other commercial value-based programs. 

That doesn’t surprise me. After all, these leaders realize that:

  • A large percentage of their organization’s business is still focused on a fee-for-service model and not completely focused on a risk- or value-based model yet
  • They’re not quite sure, as they begin to embrace that latter model, how they’re going to assemble the people, processes, and technology they’ll need to succeed in this new paradigm while maintaining the fee-for-service margins they’re used to

So they’re taking incremental steps with their technology-adoption process, adding components in a piecemeal fashion.

And while it’s good to see them embracing technology rather than resisting it, I’m not sure this piecemeal approach is such a good idea.

For example, if an ACO purchases a couple of different analytics tools that allow them to crunch, say, claims data, but those tools prove to be too rigid to handle real-time clinical data and provide the insights clinicians need to act proactively, rather than reactively, then that ACO now faces the prospect of having to go back and add supporting tools that mitigate that rigidity.

Don’t take your ACO down this incremental path that leads to an unscalable dead end. Instead, prepare it for MSSP success by heeding these five rules right from the start.

  1. Foster a culture of collaboration. No amount of technology will make up for the lack of an integrated care network. This network should be comprised of properly incentivized specialists, community pharmacists, care coordinators, social workers, and others who support a central core of primary care physicians committed to (1) delivering proactive instead of reactive care and (2) leading the culture’s sense of collaboration with payers. To sow the seeds of this culture, I recommend starting small, with a group of care coordinators who monitor patient cohorts in near real-time and ensure proper transitions of care. It’s only once these vital members of your nascent culture of collaboration are on board that the rest of its members—all of whom regularly depend on care coordinators while executing their own duties—can be reasonably expected to collaborate effectively. 
  1. Have the right technology foundation, and by that I mean have the tools that aggregate lots of different types of data from multiple disparate sources, like pre- and post-adjudicated claims data from payers, data from multiple electronic medical records systems, and even data coming from the patients themselves. For example, one network I’ve been working with lately has provided internet-enabled body scales to its congestive heart failure (CHF) patients in an effort to manage them better. ACOs need the right technology in place to be able to efficiently ingest and analyze these new and different data types.
  1. Stratify your patient population into high-risk and rising-risk patients. Technologies that help predict the onset of diseases like asthma, chronic obstructive pulmonary disease, and CHF will give your ACO the information it needs to intervene with the rising-risk patients promptly. Additionally, make sure your tools have the algorithms to find multiple types of patients who have the various conditions your ACO is concerned with, enroll those patients into care-coordination groups, and single out those patients on an ad hoc, one-by-one basis. For example, a client of ours had an elderly widowed patient who had missed some important appointments because she no longer had anyone to drive her to the hairdresser and she was self-conscious about her appearance, even when it came to seeing her doctor. While this patient wouldn’t have been detected by a risk-stratification tool, a care coordinator was able to place her as an individual on a watch list and arrange for her to get to the hairdresser and make attending important appointments more comfortable, and therefore actually possible.
  1. Ensure access to the data, and ensure that that access is in real time and an integral part of the work flow. You’re going to want to have notifications for significant events like patient admissions and discharges, the appearance of unusual lab results, and other items so you or your care coordinators may intervene in a timely manner. This access will help you prospectively address your population’s gaps in care so that the information doesn’t arrive too late as part of an aggregated set and you can actually achieve your lower-cost-per-episode goals. It’s the difference, if you will, between receiving a report that details all the times one broke the speed limit in the past year and actually being pulled over each time—the latter feedback method is, presumably, much more apt to trigger a remedial action.
  1. Look forward. Once the first four rules have been heeded, make an effort to fully recognize just how quickly precision medicine is coming at us. Everyone from President Obama to the folks in academia to cancer researchers is talking about it, but so are community hospitals, ACOs, and clinically integrated networks. Prepare yourself to move beyond the “who” and “what” of the items mentioned above—the tools and the processes and the people—so that you can actually treat your patients in an individualized manner, and in a way that will best assure the optimal outcomes given your patients’ previous medical histories, genomics, social activities, exercise habits, and other circumstances.

While the anxiety around the reimbursement initiatives of the MSSP and other value-based plans is understandable, don’t let it prompt you to take a piecemeal approach to your technology-acquisition efforts.

Instead, heed these five rules in these early days, equip your ACO with the right technology infrastructure and tools right from the start, and take the limits off the positive outcomes, cost savings, and overall competitiveness your ACO deserves to enjoy. Your patients—and your business—are counting on you.

*** 

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