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Start slashing unnecessary costs while boosting care quality.
So, you’re in the thick of it with an Accountable Care Organization (ACO) – whether you’re navigating the Medicare Shared Savings Program (MSSP) or diving into the REACH (Realizing Equity, Access, and Community Health) model. These initiatives are all about slashing unnecessary costs while boosting care quality. But let’s be real, it’s a wild ride with plenty of bumps along the way. To help you steer through, let’s dive into the common pain points ACOs face and how you can tackle them head-on…
Understanding the MSSP and REACH Models (A Quick Refresher)
MSSP (Medicare Shared Savings Program):
- Aim: Achieve cost savings while maintaining or improving care quality for Medicare beneficiaries.
- How: Different tracks with varying risk-reward levels to encourage accountability.
REACH (Realizing Equity, Access, and Community Health) Model:
- Aim: Address health equity and ensure high-quality care for underserved populations.
- How: Focus on community health, prevention, and tackling social determinants of health (SDOH).
Common ACO Challenges and Solutions
Data Integration and Management:
The Problem:
Your data is everywhere — EHRs, claims, SDOH info. It’s like trying to piece together a jigsaw puzzle with missing pieces. The result? Incomplete patient profiles and poor care management.
Fixing It:
– Get a robust data integration platform that can consolidate all that info.
– Use advanced analytics and AI to turn data into actionable insights.
– Prioritize data governance and security to keep patient info safe.
Care Coordination:
The Problem:
Trying to get all your providers on the same page can feel like herding cats. Fragmented communication means care is all over the place, leading to unnecessary acute utilization.
Fixing It:
– Develop a centralized care coordination system for seamless communication.
– Hire care managers to oversee high-risk patients and ensure continuous care.
– Use real-time alerts (like ADT alerts) to keep everyone updated on patient status.
Managing High-Risk Patients:
The Problem:
High-risk patients are the frequent flyers of emergency and inpatient services, driving up costs and demanding intensive management.
Fixing It:
– Use predictive analytics to spot high-risk patients before they spiral.
– Create targeted care plans with regular follow-ups and behavioral health support.
– Address SDOH factors like housing instability or lack of transportation to reduce high-risk status.
Financial and Performance Risk Management:
The Problem:
Balancing the books while meeting performance benchmarks is like walking a tightrope, especially with the varied risk-reward structures in MSSP and REACH.
Fixing It:
– Tap into shared savings programs and incentives to cushion financial risks.
– Keep a close eye on financial and performance data to stay on track.
– Bring in financial experts to tailor risk management strategies for your ACO.
Addressing Social Determinants of Health (SDOH):
The Problem:
SDOH — like income, education, and housing — are the invisible hands shaping patient health. But integrating them into your care strategies? Easier said than done.
Fixing It:
– Collect and analyze SDOH data to uncover barriers to care.
– Partner with community organizations to provide essential resources for patients.
– Educate your care teams on the importance of SDOH in patient assessments.
Regulatory Compliance and Reporting:
The Problem:
Keeping up with the never-ending stream of regulatory requirements and reporting obligations is a full-time job, and non-compliance can hit hard.
Fixing It:
– Use compliance management tools to streamline reporting and stay compliant.
– Stay updated on MSSP and REACH policy changes through continuous learning from trusted sources.
– Consider hiring compliance experts to navigate these choppy waters.
Steering Towards Success
Identifying and tackling these pain points is your roadmap to ACO success in both MSSP and REACH models. With the right tech, teamwork, and comprehensive care strategies, you can cut unnecessary acute utilization and improve patient outcomes.
At Acclivity Health, we’re here to support you. We offer solutions tailored to the unique challenges of ACOs, helping you manage risks, integrate care, and address social determinants of health. Ready to ace your value-based care goals? Let’s chat and see how we can help you navigate the journey.
Feel free to reach out if you need help with identifying and addressing your ACO’s pain points! Or you can read more about setting up your ACO for success here.
Author:
Stacy Fox | Vice President of Sales, Acclivity Health
