Shutterstock/everything possible
1.10
THINGS 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.
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO
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
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO
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
Ten Things a Practice Needs to Be Successful in an ACO
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.
Ten Things a Practice Needs to Be Successful in an ACO