If you are participating in an ACO, or hope to participate in one soon, here are some of the biggest changes you will need to make:
1. Increase patient engagement. Much of your success in an ACO will depend on improving the quality of care you provide patients, and reducing the cost of care you provide. One way to do that: better engage patients in their care.
Do they come in for follow-up visits? Do they comply with your treatment plans? Do they come in for annual visits? The more you can answer yes to these questions — and similar ones — the more likely it is you are keeping your healthy patients healthy, and your patients with chronic conditions stable.
"It's one thing to improve the quality and reduce the cost [for] people who already have problems; that's very important," Mark Wagar, president of Heritage Medical Systems, an affiliate of California-based Heritage Provider Network, which is also an affiliate of the Heritage California Pioneer ACO, told Physicians Practice. "You aren't going to be successful in the long run and physicians aren't going to be in a position to lead like they need to in the healthcare system if you don't also change the incidence rates of how some of these chronic and predictable downhill slides occur, or at least intervene and reduce their severity by helping their patients and family engage differently in their own healthcare."
2. Better coordinate patient care. As an ACO participant, you will need to work more closely with other providers and health systems to more thoroughly track and monitor your patient throughout the healthcare system.
For primary-care physician participants, you will also need to coordinate with other non-traditional resources to ensure patient have access to a variety of healthcare resources.
Physicians will need to consider several factors when caring for patients included in the ACO such as emotional health and behavioral health status, other complex medical issues, and home situation, said Wagar. "You're going to be looking at and wanting to do entirely different things. Connecting [patients] with community organizations that may surround [them] with more social and economic resources that may have nothing to do with [their] health benefits plan under Medicare, but may have everything to do with whether [they're] able to successfully navigate health status to an improved level."
3. Know your data. Much of your success at improving care quality at reduced care cost will hinge on whether you have patient data at your fingertips, and whether you are able to use that data to your advantage. For that reason, physicians need to ensure they have access to patient data before they even begin participating in an ACO, Cindy Dunn, a senior consultant at the Medical Group Management Association, told Physicians Practice. "You're [going to need to be] able to look at your population of patients and see how many you have of each kind, age, what are your top diagnoses; and then you need to be able to look at episodes of care, so everyone we have that's got hypertension and diabetes, this is how many visits they've had in the past year and these are the things we've done. You really have to know your patient population."
4. Embrace technology. Along with better utilizing data, you will need to have the technology capabilities to better track and monitor data. For that reason, Dunn said it's critical to have an EHR or a registry, and to seriously consider acquiring a patient portal. "You've got to engage the patient, and the only way that you can be efficient and share information is electronically," she said.