10 Keys to ACO Success

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October 10th, 2012

Payer-Provider TeamworkAs hospitals, physician groups and other providers position themselves to participate in Accountable Care Organizations, there are many issues that require consideration. Below are 10 steps and issues that should be taken into account in order to create a solid infrastructure and achieve long-term ACO goals.

  1. Understanding and Management of ACO Costs

    Estimating the initial investment required to form an ACO will ensure that the organization has capital to build the necessary IT and other infrastructure. Maintenance of the IT system alone has been estimated by CMS to be 15 to 20 percent of initial costs.  The vigilant management of costs is also necessary for the ACO and participating providers to receive incentive payments and realize the true potential of shared savings.

  2. Know Your Potential Patient Base

    Detailed information on the patient population being served and how they utilize medical services aids in projecting where they will access care, the services required and the frequency of utilization.  Strategies such as forming disease registries for chronic condition patients can help ACOs assess the status of their patients and encourage compliance to treatment plans.  Moreover, there must be a significant number of patients to share in the costs of ACO development.

  3. Create a Sustainable Business Model

    Forming a business plan that includes a diverse portfolio of income possibilities will position the ACO to prosper despite an inevitable decline in inpatient volume.  New business models may incorporate services like telemedicine, providing at-home outpatient care and a variety of preventative services to ensure overall health.

  4. Develop a Team-Based Mentality

    Cultivating a team mentality is key for encouraging providers to work together and develop a combined sense of responsibility for patient health. Hospitals, skilled nursing, assisted living, medical homes, hospices, practice groups and rehabilitation centers may all play a role in delivering patient care in an ACO system. Working in a coordinated and interdependent fashion is a key component of ACOs and their potential to deliver successful, efficient care to patients.

  5. Adapt or Develop ACO specific IT Systems

    Information Technology systems are crucial in supporting ACOs in the monitoring and reporting of cost and quality data.  ACOs also require real time patient data to flow between providers and insurers to enable coordinated patient care and foresee future potential cost savings.  Adapting an IT system that efficiently hosts data and interoperates with other healthcare IT systems is essential.

  6. Physician Buy-In

    In order for the ACO structure to stand, persuading physicians to abandon fee for service and volume based medicine is key.  Incentivizing physicians to make a change with only negative penalties will prove to be ineffective.

  7. Patient Involvement

    Patient involvement at the beginning of ACO development will aid in fine-tuning the design of the care delivery model as well as providing education on preventative care, wellness and ACO services to the population being served. Educated patients who are involved in their own healthcare are more likely to seek the appropriate care for their needs and make healthier lifestyle choices.  Some even suggest patient participation in the governance of ACOs.

  8. Employer Engagement

    Employers will want to see cost and quality data demonstrating how ACOs will improve healthcare for their employees and reduce their costs.  Greater transparency of pricing and quality indicators will give employers the chance to see if savings are being achieved and provide an incentive to participate.

  9. Assess Physician Skill set and Educate

    The skill set of physicians and staff should be assessed in regard to technical ability and knowledge.  While ACOs should adapt an IT system that is user friendly, individuals not familiar with technical concepts must get up to speed. It may require teaching seminars or training sessions to position staff at an efficient advantage.

  10. Monitor and Share Performance

    It is important to monitor and share the performance of the ACO on specific metrics and goals.  These metrics measure cost savings and reduction of unnecessary care, but also measure qualitative metrics like the success of facilitating care coordination and patient satisfaction. Sharing of this information is a crucial component for empowering patients and motivating providers.

PayerFusion is a Health Plan Administrator and Cost Containment company offering comprehensive solutions for self-funded employers and international payers.  Our health plan administration solutions are customized to meet the needs of our clients and include provider network design/support, policy design, full-service TPA, technology solutions/support and informatics.  Contact us for more information and to learn more about our health plan administration services.