Healthcare News & Insights

ACOs: What to do and what not to do

People in the healthcare industry hear a lot about accountable care organizations. ACOs create incentives for healthcare providers to work together to treat an individual patient across care settings – including hospitals. And Medicare’s Shared Savings Program will reward ACOs that lower growth in healthcare costs while meeting performance standards on quality of care and putting patients first. 

MedicalTeamWhen an ACO is successful in delivering high-quality care at a more affordable cost, the ACO shares in the savings it achieves for the Medicare program.

3 Keys

If your facility is planning on becoming part of an ACO, here are some useful tips from Judy Rich, CEO of Tucson Medical Center, which is part of Arizona Connect Care, one of the 27 original CMS Medicare Shared Saving Program (MSSP) participants.

  • Share the big picture — While you may be able to see the pot of gold at the end of the ACO rainbow, not all hospital leaders can.  Rich had to share with her board and physicians how the facility was going to survive on less-invasive procedures  and shorter hospital stays. What you have to get across to them, she explained in Becker’s Hospital Review,  is patients will want to be treated at hospitals that provide efficient/quality care. Plus, in the MSSP, the hospitals that have the data showing they cut costs and improved patient care get bonus payments. Leaders have to be able to look past everything else to see the pot of gold at the end — healthier patients and a better healthcare system for everyone.
  • Don’t go it alone, partner up — Positive and constructive relationships are essential to the survival of ACOs. That includes relationships among physician partners, technology partners and patients. All physician partners involved in the ACO need to be committed to providing quality long-term care at a reduced cost, which takes a desire to change health care. Arizona Connected Care partnered up with Optum, a health service business, that helped the ACO organize how it would share patient data and organize information technology among the organization’s partners. Building partnerships with patients is key.  ACOs that get patients to be personally accountable and engage in their continuum of care are much more likely to be successful.
  • Align with community health needs — Arizona Connected Care’s community is very diverse and has large student, military (active and veterans) and Hispanic populations, among other groups. Before it formed the ACO, the hospital studied its community and looked for trends within its population so it could create integrated care models specific to the people in its community.

3 Pitfalls

Becoming part of an ACO is no easy undertaking. It is a long and involved process that takes a lot of preparation and work. The last thing hospitals want to do is make a mistake that could submarine the process. Here are three pitfalls hospitals need to avoid at all costs:

  • Failure to make technology a high priority — A major part of an ACO is providing outcome data to prove the organization is making patients better faster and for less money. If you don’t have the proper technology to share and exchange data at the point of care that proves outcomes, your ACO won’t be successful.
    However, even the best system won’t be worth anything if the physicians in the ACO don’t know how to properly input the data. So make sure your physicians get the training they need to input the data properly.
  • Making the hospital the center of care — The center of care in an ACO should be the patient, not the hospital. And everyone involved in the ACO has to be on board with that concept. Rich says that while a hospital must be efficient at gathering and entering patient data, the data can’t be the focus. It is a means to an end, which is patient care.
  • Excluding payors — Many payors and providers have an adversarial relationship and, therefore, don’t share well. But in order for an ACO to be successful, a new way of thinking — having payors as partners not enemies — has to be instilled. Payors know a lot about risk management and have a lot of data on the subject. Sharing information can only help an ACO. Everyone involved in an ACO has something positive to share.

For more pitfalls, click here.


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