When starting in an ACO for the first time, it can seem like there are 10,000 things to do and all the items feel like the number one priority. Whether you are the ACO contract holder, meaning you are the legal entity responsible for the risk, or joining an ACO as a participant provider, I have found three key items as the top priorities for success with new ACOs – effective provider engagement, care management programs, and a quality analytics program.
When looking for provider groups to join your ACO, make sure before signing the contract that they agree with your ACOs goals and plans for success. Having providers who are aware of how their care impacts the overall success on the performance metrics and total cost to the ACO is one step and can be taught to a willing provider. Having the providers be a part of the ACO decision making provides opportunities for increased sense of ownership and goals and improves the ability to understand how their actions impact goals for quality and cost. Also, especially for MSSP ACO contracts, using a CEHRT EHR will allow for obtaining the Electronic Clinical Quality Measures (eCQM). Find physician champions to advocate for using evidence-based best practices, continuous quality improvement, standardization, and improved efficiencies as a part of your provider engagement plan. If you are the provider group joining an ACO, be prepared to work in a team meeting team goals and be open to the learning process. Ask for educational support from your ACO contract holder on culture management and specifics of process measures that are unclear. Switching to value-based care (VBC) is a transition that requires support – ask before signing a contract to be a participant in an ACO how the ACO contract holder will support your practice in this transition.
Choosing a provider who has a large number of potentially aligned and attributed patients but who does not engage in evidenced-based process measures that the ACO contract holder has designed to control total cost of care and improve quality will ultimately cause the ACO to not meet their goals.
Care Management is, as one of my clients calls it, the “secret sauce” to successful patient engagement and improved outcomes through coordinated care and follow up. Research has shown that not all your patient panel requires care management services – billable or not – to have a significant impact on benchmark goals. Focusing on the patients who have the most risk for inpatient admissions/readmissions, fragmented care with multiple providers involved, patients in transitions between locations of care, and disease specific needs such as diabetes support, cardiac care support, or respiratory care support can have huge impacts in overall total cost of care and utilization measures. How many patients receive care management services depends on your bandwidth, so being able to identify who the highest risk patients are requires a good health analytics system (more on that below.)
Population health transition requires the ability to view and distribute data on risks and outcomes in an easy to view manner for the providers to use. Ensure that provider scorecards are made available to your provider groups frequently since lack of feedback can be interpreted as “good news” for the provider group. Make it clear where the providers are in relation to goals of the ACO as without this feedback, the provider group may not see the data as requiring any actions. Work with the provider groups on how to impact these areas to meet the goals as they likely need additional assistance to transform their practice. Deliver actionable data to the provider groups including care management enrollment, HCC score trending and appropriate recapture rates, Annual Wellness Visit (AWV) completion rate, readmissions, and use of the emergency department for potentially avoidable reasons. Risk stratification of your patient panel allows for increased contact with the highest risk patients between provider visits as well as during transitions in care. Understanding and managing patients with total risk for high spend in the next 24 months is ultimately more essential to the program’s success than trying to focus on things that happened in the past not repeating themselves – except those readmission risk scores. Area Deprivation Index (ADI) and Social Determinants of Health (SDOH) support allows for an in-depth view of your population’s non-medical needs that impact their health care utilization and can assist with targeting the direction your organization needs to move with community outreach and Community-Based Organization (CBO) collaboration. AWV and preventative visit alerts are essential as is knowledge of the potential gaps in care for screenings and immunizations that can help with maintaining health in your patient panel. Preventing a stroke is much more effective to both the patient’s and the ACO’s goals than treating the stroke and will ultimately reduce total costs for the long term.
Ultimately, partnering with the right ACO contact holder and the correct participant provider groups who are in step on how to proactively manage patient risk using care management and data analytics to track performance is attainable. Acclivity can help with all of these steps – So get in touch!
Visit the Acclivity ACO page for more information and helpful resources.
Carol Javens, RN, BSN, CHPN | Account Manager, Acclivity Health Solutions