Addressing Unnecessary Acute Utilization in Healthcare: A Strategic Approach

Improve Patient Care & Reduce Costs By Addressing Acute Care Over-Utilization

In the complex landscape of healthcare, Accountable Care Organizations (ACOs) are pivotal in transitioning from fee-for-service to value-based care. This shift aims to improve patient outcomes while reducing costs. Insights from 10 leading ACOs have uncovered pivotal strategies that drive their success. Effectively understanding and mitigating these factors is essential for improving patient outcomes and decreasing overall healthcare expenditures.

Key Drivers for ACO Success

Patient Centric Focus & Engagement 

• Patient Focused: Ensuring that patient care and outcomes are at the core of all decisions and processes.
• Addressing Social Determinants of Health (SDOH): Integrating SDOH into care plans to address broader factors affecting patient health, such as housing, nutrition, and transportation.

Data Analytics & Technology  

• Leveraging Technology: Utilizing advanced health IT systems and population health platforms to improve data sharing, monitor outcomes, and facilitate care coordination.
• Analytics for ACO Insights: Employing data analytics to identify high-risk patients and drive targeted interventions.

Clinical Transformation 

• Population Health Strategies: Implementing proactive approaches to manage the health of populations and prevent hospital readmissions.
• Enhancing Quality Measures: Focusing on quality metrics to ensure high standards of patient care and regulatory compliance.

Unnecessary Acute Care Utilization is a Significant Driver of Costs for ACOs

Addressing unnecessary acute care utilization is crucial for achieving these goals. By exploring key strategies and understanding the factors that contribute to excessive acute care, ACOs can enhance patient care and manage costs more effectively.

1. Increased Emergency Department (ED) Visits: Patients often turn to EDs for non-emergency issues due to barriers in accessing primary care or lack of health literacy.
2. High Hospital Admissions and Readmissions: Frequent and avoidable admissions strain resources and inflate healthcare costs.
3. Resource Allocation: Acute care episodes consume a disproportionate amount of healthcare resources, diverting funds from preventive and chronic care management.

These factors not only escalate costs but also compromise the quality-of-care patients receive, leading to poor outcomes and inefficiencies.

Acute Reduction Module (ARM)

Acclivity Health’s Acute Reduction Module (ARM) is designed to help Accountable Care Organizations (ACOs) effectively reduce unnecessary acute care utilization. ARM leverages data analytics and predictive modeling to analyze claims data and forecast high-risk patients likely to experience acute events or readmissions. This proactive approach allows for targeted outreach and management. The system also provides real-time Admission, Discharge, and Transfer (ADT) alerts, ensuring timely care coordination during critical transitions. Additionally, ARM supports participation in value-based care models, such as shared savings programs, where reduced acute care utilization leads to financial benefits for providers. To enhance care coordination, ARM empowers care managers to guide high-risk patients through the healthcare system and supports seamless transitions of care utilizing workflows, thereby minimizing readmissions and ensuring effective follow-up.

Acclivity ARM is a powerful component of Acclivity Health’s broader enhanced Platform coming soon that is designed to bring comprehensive insights, trending, benchmarking, and advanced dashboards to ACOs. While ARM focuses on reducing unnecessary acute care utilization through real-time alerts, predictive analytics, and enhanced care coordination, it represents just one-use case within a versatile suite of tools. The Acclivity Platform goes beyond acute care, providing ACOs with a holistic view of their operations and patient populations. It integrates data from various sources, enabling robust analysis and visualization across multiple domains. This comprehensive platform empowers ACOs to make data-driven decisions, optimize care delivery, and improve patient outcomes across the continuum of care. Acclivity Health ensures that ACOs have the resources they need to address immediate challenges and the strategic insights to drive long-term success in a value-based care environment.

By implementing these strategies and leveraging ARM, ACOs can reduce unnecessary acute utilization, improve patient outcomes, succeed in the value-based care, and lower overall healthcare costs. Our proactive, data-driven approach addresses both the medical and social needs of patients, fostering strong care coordination and analytics. 

• Immediate Cost Savings: Reducing unnecessary ED visits and hospital admissions can lead to substantial cost savings.
• Enhanced Patient Outcomes: Improved care coordination and proactive management translate to better health outcomes and patient satisfaction.
• Regulatory Compliance and Incentives: Staying ahead in value-based care models and shared savings programs can provide significant financial incentives.
• Operational Efficiency: Streamlining care processes and reducing administrative burdens enhance overall efficiency and resource utilization.

For additional information on reducing unnecessary acute care utilization, or more on the new ARM solution from Acclivity, set up a quick meeting.

Author:

Stacy Fox | Vice President of Sales, Acclivity Health