As more healthcare organizations plan to begin their transition to accountable care, it has become clear that there are a variety of factors that influence where they are ready for these changes. These organizations have learned the journey to an ACO is not an “all or nothing” process due to the number of different payment models available for each company and the eagerness to begin transitioning. Many organizations find that taking a phased approach will increase their chances of success.
Evaluating readiness to change
First, and perhaps most important, leaders need to be aligned around the need to for change. From there, the organization can determine what is needed to support new care and payment models and assess where gaps exist. This might require investments in health IT and staffing as well as outside sources to improve workflow and patient health.
If the leaders agree with the vision and are motivated to invest in resources based on the potential to increase market share, a rapid transition may be possible. These companies will be positioned to move quickly toward a clinically integrated network structure if one is not already in place, and can begin building a strong foundation for value-based care.
Developing a plan to consider the approach and gain participation from doctors, patients, partners and leaders is essential. Determining the right payment model, creating incentives and investing in technology and patient health are crucial for long-term success.
Choosing the right payment and incentive model
There are many payment models that balance risk and reward, depending upon the organization’s readiness. The early steps can include taking part in shared savings programs and leveraging care coordination fees from payers. Signing agreements with payers to implement agreed-upon efficiency improvements and get paid for better results are a good way get experience with value-based care payment models. Some organizations are exploring models that combine both fee-for-service and performance-based components for unique patient groups such as Medicare patients. Only organizations that are well-positioned in the market and ready to make essential investments will want to consider becoming a full ACO.
Improving patient health management and care coordination
Regardless of whether a health system or provider group is ready to become a full ACO, improving population health is important for future success. Wellness and disease management programs must create measurable results. Health strategies must be data-driven, targeted and effective to promote real behavioral change. Meaningful patient information must be exchanged to meet these criteria. Personalized care plans coupled with the right access to data ensure everyone is treating patients with a unified, thoughtful approach.
A holistic take on individual health is also essential to manage patients with costly and complex conditions. Today’s consumers expect customized outreach based on their unique lifestyle and wellness needs. Patient engagement tools that incorporate social media and mobile applications are proving to be in demand. These tools can connect patients with their personal health information, allow them to schedule doctor appointments and provide peer support. When incorporated into the patient/doctor relationship, these applications can help individuals take greater ownership of their health.
Investing in intelligence
Just as advanced analytics will drive more effective patient health management at a broader level, new technologies can also provide clinical decision support at the point of care. Electronic medical records are a step in the right direction, but overwhelming providers with data is not the key to improving health care quality. Sharing important patient information and matching it with evidence-based standards will empower doctors to drive improved outcomes. Workflow tools help physicians deliver, monitor and report on care in line with new quality measures. This data will be used to create intelligent analysis and reports. These will help organizations assess results, demonstrate progress toward cost and quality goals and adjust strategies as needed.
Creating a successful pilot program
Uncertain organizations should consider a pilot program to test their models and refine their approaches. An ideal patient group should be tested for a 12-18-month period. The pilot should be large enough to show meaningful results that motivate providers through ample incentives. The organization should look at a patient group that represents roughly 20 percent of revenue in order to make enough of an impact. Pilot programs for larger organizations might consist of their own employees, which will also provide added benefits of improved morale and productivity. Once results have been analyzed and strategies have been honed for success, pilots can then be expanded with a more informed approach.
Planning for growth
Hospitals and health systems taking on greater accountability may see a reduction in participation that cannot be fully offset by value-based payments. As a result, they will need to find new ways to attract and retain patients. These strategies may include developing their own health plan in the local market, increasing steerage and identifying new ways to build loyalty through an improved patient experiences.
Just as accountable care will change the way healthcare is delivered, provider organizations need to retool their business strategies to ensure long-term financial stability.
Chris Day is National Head, Business Development and Marketing for Accountable Care Solutions from Aetna.