It's been about a decade ACOs became part of the fabric of U.S. health care. The model has proved so valuable that the drive for further improvements and savings is strong.
So, what's on the horizon in the ACO world? How can you make the most of new practices and technology?
Let's start by exploring the most compelling and valuable trends in ACOs.
If the traditional ACO was heavy on professionals, skills, and access related to care, progressive ACOs have a different mix. The inclusion of management organization has grown.
In February 2018, Health Affairs released a research report. They found that 37% of ACOs reported having a management organization as a partner. And, two-thirds of those organizations said the partner took on some of the financial risks and rewards.
This kind of management partnership offers many potential benefits. For example, greater administrative efficiency, cost savings, and capacity for care delivery.
Most often, management partners provide almost all data and administrative services. In some cases, they also provide more than half the educational and care coordination services.
Management organizations focus on behind the scenes services and invest in relevant technologies. This is the way they assume some of the risk related to operating an ACO. It is also what the bulk of their fees are for.
The savings that more efficient, robust, or integrated systems can bring is how they share in the related rewards.
But the picture for Accountable Care Organizations with management partners isn't all rosy.
Getting the Most from a Management Partnership
Often, ACO physicians and other healthcare providers aren't aware of the management partnership. If they are, they seldom know the details of the arrangement.
This can be problematic.
If management fees don't translate to value at the service level, physicians earn less. Such a situation is not uncommon.
When that happens, the financial incentives for practicing value-based care are diminished. In turn, ACOs have difficulty recruiting physicians. Delivering on all aspects of the organization's mandate becomes a challenge.
What's the best way to prevent this counterproductive dynamic? Have a value-based contract with a management partner. When compensation is dependent on service-level value revenue cycle management improves.
With that approach, the trend of management partnerships is likely to remain strong.
Innovative Health Management
From 2010-2015, the Health Care Transformation Task Force, under the U.S. Department of Health and Human Services, monitored performance and outcomes of the Accountable Care Organizations.
In 2017, they released their report. In it, they outlined what high-performing ACOs did compared to peer organizations. The Task Force defined this small group as showing "substantial reductions in Medicare spending while providing high-quality care".
Among the notable observations about the high-performing group:
- Significant spending reductions for inpatient hospital care and skilled nursing facility care
- Consistent high use of primary care services, lowering utilization and costs for other care,
- Reduction in emergency department visits and other high-cost services
One significant effect of these practices was lower cost to Medicare. High-performing organizations spent less on key Medicare services. On average, they spent $673 less per beneficiary.
So, what was different about these organizations? How did they achieve such notable gains and efficiencies?
The Health Care Transformation Task Force took action to find out.
Lessons About Innovative Health Management
They spoke with leaders at 11 of the high-performing Accountable Care Organizations. From those interviews, they found each ACO had different structures and methodologies. Yet, common themes were evident.
The Task Force grouped these themes into three categories:
- Achieving High-Value Culture
- Proactive Population Health Management
- Structures for Continuous Improvement
But what all the recommended actions boil down to is innovation. ACOs that achieved the best care and financial results didn't shy away from trying new things.
They took the risky and complex step of changing their internal view of patient care. In other words, they shifted their culture.
They knew that culture, or the way of doing things, sets the stage for all decisions. It affects decisions about technology, partnerships, personnel, and service.
In any organization, such a change requires commitment and vision from executive leadership. Each high-performing ACO had that kind of leadership. In many cases, they were open with employees about adopting an attitude of innovation.
Borrowing a page from the high-tech world, the ACO leaders also fostered a culture of innovation. To do this, they allowed teams to:
- Prototype and fail fast
- Collaborate across functions
This way of doing things is not common among Accountable Care Organizations. But things are changing. Each ACO that embraces an attitude of innovation will find new paths toward better health management.
The Future of ACOs
Rising costs and legislative changes will always put new pressures on Affordable Care Organizations.
Continuous improvement is at the heart of the future of ACOs. And, that is dependent on innovation and integration.
Leverage the most valuable aspects of care providers and administrative support. Tap into the best from technology providers. Use best practices for revenue recovery management.
Synchronize the pieces within a high-value culture and you're poised for success.
At DECO, we come to the table with deep expertise. We excel at the effective and efficient conversion of potential bad debt into revenue. Since 1993, we have worked with hundreds of hospitals and other care facilities. Each time, we ensure recovered revenue flows directly to the bottom line.
We take a compassionate and empathetic patient-advocacy approach to eligibility services. Our approach is the same for uninsured and underinsured populations. At the same time, we dedicated to enhancing patient satisfaction.
To find out more about how our services can integrate and help get the most of latest ACO trends, contact us today.
Pete is the Vice President of Sales & Client Services at DECO Recovery Management. He covers the Mid Atlantic region and specializes in Medicaid related topics. It is DECO’s Mission to maximize reimbursement to our clients by leveraging innovative technology, processes and compassionate advocates to provide exemplary service.
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