If approached about participating in an accountable care organization (ACO), it’s critical for practices to seriously consider their options, and make smart decisions about whether participating is right for them.
To help, here’s an ACO readiness checklist provided by Aetna Accountable Care Solutions. Check off every item, and you’re likely ready to participate in an ACO. If you can’t check off every item, use this checklist to begin forming a plan to work toward value-based reimbursement.
- Internal culture and leadership. Value-based care requires a complete transformation of many business and financial processes. For a large practice, leadership must be aligned with this vision and have the ability to implement change management strategies throughout all levels of the practice. For a group of disparate practices coming together to form an ACO, leaders of the physician organization must align the vision among all practice leaders before change management can be implemented.
- External factors. Some organizations will be more motivated to move into value-based care models quickly if strong competitive forces and/or market growth opportunities provide additional incentives to make the transformation.
- Organizational structure. CMS requires ACO policies, organization, and structure to improve quality and efficiency in order to achieve shared savings. To do this, leadership must align on their governance structure, provider agreements, data analytics, and the structure of the financial model to outline how savings will be distributed.
- Value-based care strategies. Clinical integration provides a strong foundation for successful accountable care. Based on a practice’s level of integration and access to resources, they will want to explore whether to participate in one or multiple value-based initiatives, which include Patient-Centered Medical Homes, shared savings programs, or a full-fledged ACO.
- Technology and data infrastructure. In order to foster a team-based, collaborative approach to care, technology must be in place to connect patient data and provide advanced clinical insight. Practices will need access to work flow tools, decision-support analytics, and population health reporting in order to improve patient health and measure progress against quality metrics.
- Population health management capabilities. Data-driven population health improvement strategies will allow practices to successfully manage patient risk in order to share in the rewards of higher quality care.
- Strong potential collaborations. For practices without risk-management expertise or extensive capital and technology resources, payer-provider collaborations can provide a good starting point for the transition to value-based care.
- Change management plan. Prior to implementation, practices need to plan for the changes in work flow required to operate in a value-based care environment. Planning ahead can help minimize inefficiency and staffing pressures.