What you need to know about Health Reform, Accountable Care, and Collaborative Care

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1 ACO and Collaborative Care - The Basics What you need to know about Health Reform, Accountable Care, and Collaborative Care Healthcare is changing Costs vs. volume ACO Benefits How to Achieve ACO

2 Health reform is real and not going away. Healthcare is changing Health reform is real and not going away. People are living longer but not necessarily healthier. As a result, care is more costly and inefficient. That s where health reform comes in. Health reform is not any one government or commercial program. It is not an Accountable Care Organization (ACO), Patient Centered Medical Home (PCMH), Health Home (HH) or Medical Neighborhood (MN). Health reform is all of this and more. Health reform is care delivery reform, payment reform, and health and healthcare community reform combined.

3 These three cornerstones transcend any one practice model to focus on clinical and financial value and outcomes. Care Delivery Reform Collaborative care models that blend organizational, clinical, financial, and technical interventions. Examples include, but are not limited to, ACO, PCMH, HH, and MN. Payment Reform Economic change in provider reimbursement. The traditional models of volume-based rewards and who pays for care are being challenged. Payer innovation is happening that includes self-insured providers, employers, public and private insurers, and even patients in new roles. Health and Healthcare Community Reform Traditionally, healthcare happens at a clinician visit. However, to manage the overall health of a patient and truly affect outcomes, broad community engagement is critical. New types of community and wellness partners are working with clinicians on innovative ways to improve health. What is Collaborative Care? Its components include patient-centered care with an orientation toward the whole person, comprehensive care, care coordinated across all the elements of the health system, superb access to care, and a systems-based approach to quality and safety. i Ultimately, these components are intended to improve patient outcomes including better patient experience with care, improved quality of care (leading to better health), and reduced costs. ii What is an ACO? An organization, virtual or real, that agrees to take on the responsibility for providing care for a particular population while achieving specified quality objectives and constraining costs. iii

4 Cost drivers - value vs. volume It is widely acknowledged that the cost of healthcare will continue to rise. As healthcare becomes a greater portion of expenses for employers, public and private insurers, and even patients, there is an increasing focus on efficiency and value. Given this pressure to achieve better value for healthcare, it is safe to assume that investment will level off and likely begin to decrease over time. The sooner providers adopt collaborative care models, like ACO and PCMH, the more likely they are to increase value and not only share in savings, but share in a greater portion of the system savings. Achieving results, however, is a multi-year process that requires a significant investment in time and resources. Value breeds a new type of healthcare consumer. One that is more engaged, satisfied, and healthy. Patients and providers with these characteristics are fundamental to improved outcomes.

5 Value has become competitively relevant Better adherence to treatment recommendations, follow-up, and prevention are all activities that affect outcomes, but are required of patients and made easier with engaged providers. Healthcare value doesn t come from volume. It is better results for lower cost, achieved by providers who develop expertise, reduce errors, increase efficiency, and improve outcomes. Value is, therefore, an indicator patients can use when choosing where to get care. To quote Dartmouth s Elliot Fisher, The best fence is a good pasture. If the grass is good, folks will stay with you. Value has become competitively relevant not just for justifying savings, but for maintaining and growing the business. v$ Public and commercial markets are deploying new payment models with value as the target. Commercial efforts have already saved millions annually. CMS actuaries project that the Medicare Shared Savings Program could save as much $1 billion over three years, which is under 0.10 percent of total Medicare spending. iv Medicaid is also launching models in over five states across the country.

6 ACO Benefits Gain immediate access to clinical information

7 Increased patient engagement and satisfaction ACO/Collaborative Care Benefits for Providers Gain immediate access to clinical information Improved workflow and care coordination Enhanced communication with all members of the patient s care team Prevent, diagnose, and treat certain diseases or combinations of conditions, in particular complex cases Improved application of evidence-based medicine through disease management protocols and clinical decision support Increased physician and staff job satisfaction by creating a hassle-free clinical practice ACO/Collaborative Care Benefits for Patients Coordinated care across physician offices and hospitals Better health outcomes Availability of full medical history accessible by all members of the care team and in case of emergency The end of repeatedly filling out forms on medical history and of repeated, unnecessary tests Increased patient engagement and satisfaction

8 NextGen Healthcare ACO/Collaborative Care Solutions How to Achieve ACO/Collaborative Care Collaborative Care is not any one product or service, it is a concept that is framed and supported first by proper business planning and then by the optimal use of organizational, clinical, financial, and technical resources. Collaborative Care does not come from out-of-the-box solutions and is not plug-and-play. It is a very business and staff-intensive concept that requires knowledgeable staff and expertise.

9 NextGen Healthcare s collaborative care experts help providers reach their collaborative and ACO goals, with services that include: Education and Strategic Planning o Health reform megatrends: The impact they will have on an organization o Organizational preparedness and transformation o New delivery models o Healthcare policy & regulatory analysis o Healthcare community partnerships Organizational Transformation o Cultural planning: staffing models, change management, new models o Clinical & business transformation o Application of technology Program Assistance o Funding discovery: matching funding opportunities to client needs o Funding-related advice, consulting, and relationship management o Funding response writing & planning o Program execution assistance based on specific programs Learn more. Watch an online demo at

10 i See home/1483/what_is_pcmh_ for AHRQ s definition of the PCMH. ii See Berwick et al. (2008) for a discussion of this triple aim of better patient experience, improved population health, and reduced per capita costs. iii Health Policy Brief: Next Steps for ACOs, Health Affairs, January 31, iv Meyer, H. Many Accountable Care Organizations Are Now Up and Running, If Not Off To The Races. Health Aff (Millwood). 2012; 31(11): v Burns LR, Pauly MV. Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s. Health Aff (Millwood). 2012;31(11): Take the next step. NextGen Healthcare Information Systems, LLC, a wholly owned subsidiary of Quality Systems, Inc., provides integrated clinical, financial and connectivity solutions for ambulatory, inpatient, and dental provider organizations. For more information, please visit nextgen.com and qsii.com. Copyright 2013 NextGen Healthcare Information Systems, LLC. All rights reserved. Contact us at Or us at [email protected] Meanwhile, watch an online demo at nextgen.com. NextGen is a registered trademark of QSI Management, LLC, an affiliate of NextGen Healthcare Information Systems, LLC. All other names and marks are the property of their respective owners.