Shutterstock/everything possible 1.10THINGS A PRACTICE NEEDS TO BE SUCCESSFUL IN AN ACO
1. AN UNDERSTANDING OF WHAT THE INCENTIVES ARE BASED ON For decades, payers whether they re insurance companies or hospital-led ACOs have been coming up with innovative contractual terms that align incentives. The problem is that most of these terms are based on claims data the provider never sees. For that reason, bonuses are a random event and often surprisingly small. And that s hardly aligned with running a good physician practice. Bill Frack, managing director and partner, healthcare services, L.E.K Consulting, Los Angeles, Calif.
2. A PLAN TO DECREASE ER AND HOSPITAL UTILIZATION RATES Patients often end up in these higher-cost sites of care because they can t get in quickly to see their primary-care physician or because they have a misunderstanding of the capabilities of the physician office versus the hospital. Preventing one unnecessary admission or trip to the emergency department can save thousands of dollars. Emilie Buscaj, recognition manager, HealthTeamWorks, Golden, Colo.
3. A PLAN TO IMPROVE PATIENT ACCESS If a diabetic is stable and well-controlled, do you need to see her every three months? Or is every four months to six months OK? Extending the time period between visits may open capacity to see sick patients more quickly as well as get more new patients into your practice. Buscaj
4. BUSINESS EXPERTISE AND FINANCIAL RESOURCES Join an ACO with the depth of professional expertise needed to make critical business decisions and with the financial resources to invest in areas that smaller ACOs aren t able to leverage. In order to be successful and to capture the attention of payers and large employers groups, your group of individual practices will need to band together through technology and a robust business support infrastructure. Andrew Aronson, chief medical officer, Privia Health, Arlington, Va.
5. A COMMITMENT TO POPULATION HEALTH MANAGEMENT Population health management gets at the core of managing the population successfully within the ACO. Often, this is an area where physician groups haven t always had a ton of experience, unless they re currently participating in other programs such as a Patient-Centered Medical Home. Population management requires a strong, underlying care management infrastructure with nurse support, care managers in primary-care offices, and the ability to stratify the population to identify higher-risk patients. Mark Fish, managing director, healthcare, FTI Consulting, New York, N.Y.
6. AN ABILITY TO TIE IN OTHER REIMBURSEMENT OPPORTUNITIES Medicare reimburses for several wellness and care coordination initiatives, including well visits and chronic-care management efforts. Utilize televisits and interact with Medicare patients at least once a year, since this can reduce emergency department visits. Sameer Bhat, vice president and cofounder, eclinicalworks, Westborough, Mass.
7. AN UNDERSTANDING OF HOW YOUR BROADER REIMBURSEMENT STRUCTURE WILL BE AFFECTED If you have a shared-savings arrangement, your fee-forservice contract with the payer won t change. Those distributions come from the ACO and are over and above fee-for-service revenues currently coming to the practice. However, full-risk arrangements, like capitation, do replace fee-for-service revenues. John P. Schmitt, managing director, Reliance Consulting Group, LLC, Atlanta, Ga.
8. THE ABILITY TO FULLY LEVERAGE THE EHR FOR ANALYTICS PURPOSES Utilize your EHR to capture structured clinical activities and encounter activities. The ACO s success will come from managing patients around cost and quality. ACO administrators will need to aggregate all of the participating provider practices data to provide information back to the practice on how physicians can be more efficient and enhance their clinical performance. If this information isn t properly captured in the EHR, it will be difficult to share. Daniel J. Marino, senior vice president, The Camden Group, El Segundo, Calif.
9. A COMMITMENT TO TRACKING REFERRALS AND PATIENT ACTIVITY Whether you re a primary-care physician or a specialist, putting in place referral tracking processes ensures that patients perform efficiently within the ACO-organized system of care. Not only is follow up between providers both primary-care physicians and specialists important, but knowing when patients don t make a referred appointment or knowing when patients go out of the system for their referral will help ACO leaders better include controls to strengthen the ACO s organized system of care. Marino
10. A THOROUGH UNDERSTANDING OF WHO YOUR ACO PATIENTS ARE Figure out the patients you re accountable for and what their needs are. Use that data to tailor outreach to them. That means meeting them where they are not just clinically, but also socially, culturally, and psychologically Josh Seidman, vice president, payment and delivery reform, Avalere Health, Washington, D.C.