Bryan Mingle, Contributing Rise Blogger
Reshaping a national mind-set after decades of practicing medicine with the emphasis on volume over outcome is the challenge and task of the Accountable Care Organization movement.
As leaders of the health-care industry are readily agreeing right now, it is a transformation of epic proportions.
Technology will assist and, in many cases, facilitate this transformation. Chances for ACO success increase when available IT tools link patients to the management of their care, when provider support staff can spot and close wellness gaps along with managing their patients' chronic diseases.
Help is on the way. Rise Health's Patient Relationship Manager platform, for one, is poised to do its part to enable the transition.
John Glaser, the CEO of health services at Siemens Healthcare in Malvern, Pa. who writes frequently about upcoming changes in health-care delivery, has thought a lot about the ACO mind-set and also recently listed six IT building blocks to support accountable care.
Here are the switches in mind-set realities that will be occurring in health-care delivery as accountable care models evolve, according to Glaser:
- from care providers working independently to collaborative teams of providers;
- from treating individuals when they get sick to keeping groups of people healthy;
- from emphasizing volumes to emphasizing outcomes;
- from maximizing the use of resources and assets to applying appropriate levels of care at the right place;
- from offering care at centralized facilities to providing care at sites convenient to patients;
- from treating all patients the same to customizing health care for each patient;
- from avoiding the sickest, chronically ill patients to providing special chronic care services;
- from being responsible for those who seek services to being responsible for the needs of the community;
- from putting forth best efforts to becoming high-reliability organizations.
Identifying, assessing, stratifying and selecting target populations. It will become imperative for providers to store, access, maintain, derive and update population data and categories (stratification) from multiple sources. Additionally, within target populations, providers will select cohorts for specific programs based on predefined metrics (cost, utilization, outcomes).
Providing care management interventions for individuals and populations. This includes patient-centered management and coordination of care events and activities in multiple care settings by one or more providers (e.g., identifying care gaps and situations requiring additional interventions, as well as managing care transitions). The aim is to manage the most complex patients through the health care system, taking their preferences and overall situation into consideration. In addition, managing the overall health of a select population (diabetics, elderly, well, etc.) will require proactive care, communication, education and outreach.
Providing high-quality care across the continuum. While this is an obvious goal for all providers, ACOs must facilitate cross-continuum medical management for active episodes and acute disease processes or for any patient outside of the defined goals of a target population. It also includes fine-tuning coordination among care team members, transition of care planning, targeting venues of care, establishing patient and family engagement initiatives, and monitoring and improving clinical performance.
Managing contracts and financial performance. With new payment models (bundled, shared savings) emerging, proactively understanding patient coverage and financial responsibility will be critical. Financial teams must have a solid handle on estimating reimbursement and associated payment distributions, carrying out predictive modeling for reimbursement contracts, measuring performance against contracts and predicting profitability, as well as integrating with other key processes to share information.
Monitoring, predicting and improving performance. With payment so tightly linked to quality and outcomes, tracking and measuring system performance in key areas become paramount in an accountable care environment. Under value-based purchasing programs, there will be real ramifications for poor care and rewards for improved care. Providers can work with their quality and clinical staff to adapt processes accordingly. In a value-based purchasing model, even low-performing areas can qualify for high payments if they demonstrate year-over-year improvement.
Across the risk spectrum, these accountable care processes will require a range of IT components and capabilities, some of which will introduce new competencies for many providers.