Look for alignments with your practice’s mission, values, and strategic priorities.
More than one-third of U.S. healthcare payments flow through an advanced payment model (APM), such as shared savings, shared risk or capitated payment. Yet for the majority of physician practices, most of their revenue is not tied to risk-based arrangements, leading to significant opportunities to participate in these models.
Accountable care organizations (ACOs) can be a good starting point for an APM journey because this type of model starts with upside risk only, which allows practices to test the waters before wading into more complex arrangements that require them to assume greater risk. While not the most flexible type of value-based care model, ACOs do offer greater flexibility than fee-for-service, paying providers for things like provider collaboration and care management, while addressing social determinants of health and more.
To realize strong clinical and financial results with an ACO model, it is critical to choose one that aligns with your practice’s mission, values, and strategic priorities. In addition, you should look for one that is committed to robust communication and support throughout the relationship. What does that look like in practice? Here are some key areas to assess.
A high-performing ACO must have a dedicated board in place whose members support the payer risk-sharing model, have influence in the local healthcare community and are respected by physician and non-physician peers. All providers participating in the ACO must be excited about the model and know their role in making it successful.
However, facilitating board recruitment and provider engagement can be time consuming, so it’s wise to look for an ACO that has a dedicated team for these activities. Such a group can handle complex tasks, including facilitating board meetings, working groups and committees, and managing contracts, credentialing and peer review. Administrative teams should ease the physician burden of ACO management and facilitate communication between all participants. To ensure the entity’s long-term viability, the administrative team should be working to identify improvement and growth opportunities and guide change management.
To accomplish its mission, an ACO needs real-time data from across the care continuum that providers can use to identify patients with care gaps and guide interventions to close those gaps. The more comprehensive the data, the more likely participating providers will have access to a complete picture of the care happening outside their four walls. This requires a platform that can automatically capture data from disparate sources and normalize it for use within different electronic health records (EHRs), so providers can use it in decision-making without having to toggle between systems. Alerts are also important, including notification about when a patient is admitted or discharged from the hospital.
Current EHRs can encourage prompt follow-up and reduce the chances of hospital readmissions. While accessing and incorporating clinical data into the EHR is essential, an ACO should also have a strategy for collecting, analyzing, and responding to social determinants of health data because these non-clinical factors can account for more than 80% of health outcomes.
Since quality is mission-critical for any ACO, it is essential that quality improvement efforts be done well. When assessing a potential ACO partner, make sure it has a sound quality strategy that spans the organization. This may involve having teams that facilitate proactive interventions like wellness visits. Or, it may entail having a group that looks at level of care decisions, such as reviewing home health services for post-acute care. Reliable and accurate quality reporting is also key. Since providers in an ACO often have different EHRs, collecting and accurately reporting quality data from across the organization can be complicated
When an ACO has knowledgeable resources committed to coordinating different quality metrics, it can make sure that what’s communicated to CMS is consistent, timely and accurate. Additionally, leaders can be sure that the ACO is focused on the most effective measures that can move the needle on care quality and cost containment.
Selecting the right ACO is critical to ensure a positive APM experience. ACO organizations that have a robust framework for administration, data analytics, and quality can enable best practice while reducing the burden on physicians, making participation easier and more profitable.