Accountable care organizations (ACOs) are synonymous with value-based care.
Launched more than a decade ago as part of the Affordable Care Act, ACOs were designed to incentivize provider groups to provide high-quality, cost-effective care by encouraging them to take on more financial risk in return for the possibility of greater financial reward.
ACOs that participate in the U.S. Centers for Medicare & Medicaid Services’ (CMS) Next Generation ACO model received some good news earlier this year when CMS announced that the program, which was originally slated to sunset at the end of 2020, was extended for an additional year as a result of operational challenges initiated by the COVID-19 pandemic.
Although the program will now cease at the end of 2021, that does not mean that the ACOs that participated in the program must abandon their commitment to value-based principles. To the contrary, most ACOs are expected to continue under other value-based programs including the newly announced CMS Direct Contracting Entity (DCE) models.
For ACOs continuing down the value-based path, it is imperative that they adopt several key building blocks that have been proven to drive success under these alternative payment models (APMs). As CFO and Chief Population Health Officer of CareMount’s Next Generation ACO, here are four steps for ACOs I’ve found are critical for yielding benefits in value-based contracting arrangements — whether in the midst of the COVID-19 crisis or under more typical operating conditions.
Invest in data and analytics: Measuring and ultimately improving clinical, financial, and operational performance is a critical function for ACOs. This requires advanced analytics tools and platforms. These resources may be used across a wide range of applications to identify gaps in care, improve care transitions, support post-discharge programs, risk-stratify patient populations, and develop care management plans. Equally important, physicians must have access to this data at the point of care and understand how to use it to integrate care across all settings and improve quality outcomes. This requires supplying the data in a format that is digestible to clinicians and care teams, in addition to offering ongoing training and support to users.
Implementing and maintaining these analytical tools typically requires a combination of external technology partners as well as internal teams experienced in data analysis, modeling and medical economics. It is virtually impossible for ACOs to succeed in value-based agreements without a solid foundation of data and analytics to clinical decision-making and transformation initiatives.
Develop a care coordination infrastructure: Patient care is a team activity, and physicians certainly can’t be expected to go it alone. Doctors must be supported by a care coordination infrastructure. The goal of care coordination is to engage chronic patients in their healthcare journeys while delivering personalized care targeted to their specific healthcare needs and issues. Care coordinators also play an essential role for ACOs in critical areas such as promoting annual wellness visits, discharge planning, care transitions and reducing emergency room utilization. By directing patients to the most appropriate care settings, care coordinators help ensure patients obtain the care they need while avoiding unnecessary utilization.
Prioritize patient communication: As much as data and analytics form the basis of value-based performance measurement and improvement, strong patient-provider communication is a bedrock of high-quality patient care. Care coordination and patient outreach teams generally perform much of the heavy lifting associated with patient communications.
ACOs and other providers have many channels available to communicate with patients — online portals, text messages, emails, social media, websites — but should endeavor to use each patient’s preferred options after confirming with patients. By strengthening communication channels with patients, ACOs can begin to help patients address challenges related directly to chronic medical conditions, as well as social determinants of health such as transportation, housing, and food insecurity.
Ensure physician alignment and engagement: To optimize performance under value-based contracts, ACO physicians must engage with and clearly understand the basic principles and incentives of value-based care. This means emphasizing the importance of wellness visits and timely follow-up and tailoring advice to patients. It is also critical that physicians realize the importance of performing well in quality and patient satisfaction measures, as well as the necessity of comprehensive documentation, which are essential to being accurately and properly compensated under value-based agreements. Finally, ACOs must incentivize physician adherence to value-based principles by tying physician compensation to program goals.
Even as the federal government’s commitment to the ACO model evolves, the medical groups and health systems that have achieved success under these models must remain committed to operating under value-based care principles. For ACOs that continue down this path, executing on the above building blocks will afford the best opportunity for success under value-based reimbursement models.