Why are accountable care organizations (ACOs) such a big deal? What do I really need to do and how should I prepare right now?
Dear A.C. UH-OH:
You’re not alone. Many healthcare providers have more questions than answers when it comes to delivering accountable care. The bottom line? Healthcare is changing – and fast. To stay competitive and deliver optimal patient care you need to ride the ACO wave successfully. Here are some quick answers to help you unravel the complexities of ACOs and decide on the best next steps needed to position your practice for long-term success.
Why are ACOs a “big deal?”
Healthcare is shifting from fee-for-service to new pay for performance delivery models, AKA value-based care. An ACO is just one of the value-based care delivery models that are defining healthcare transformation.
The Affordable Care Act ushered in a new approach to care – one in which a network of doctors, practices, and hospitals (together called an ACO) share financial and medical responsibility for patients. Their goal is to coordinate care, improve outcomes, and eliminate unnecessary healthcare costs. If your ACO saves money, you get to keep a portion of that savings – assuming you can demonstrate that you’re doing a good job of keeping your patients healthier and out of the hospital.
It’s also important to note that the regulations governing ACOs are subject to change. In our ever-changing healthcare environment, it’s imperative to keep an ear to the ground to ensure your organization is agile.
How do ACOs work?
ACOs are incentivized to deliver high-quality and low-cost care and are graded on quality measures reporting to ensure patients receive the care they need. And, while ACOs don’t necessarily eliminate fee-for-service, they do present incentives for physicians to be more efficient with bonus opportunities when providers keep costs down. Doctors and hospitals have to meet – and report on – specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases.
According to CMS.gov, the share of Medicare payments flowing through alternative payment models has grown from 20 percent in 2014 to 30 percent as of April 2016, and the number of physicians and other clinicians participating in these payment models has grown as well.
Your next steps to accountable care
Value-based care – and the demands on you to transition successfully – are not going away. To prove you’re meeting value-based care criteria, you need to:
• Demonstrate meaningful use of a certified EHR (to meet evolving regulatory requirements)
• Connect, collaborate, and coordinate care by exchanging clinical and financial data (interoperability)
• Measure, monitor, and manage your patient population
• Improve your patients’ care experience
• Document, track, and report on your results through your certified EHR
How will you define ACO success?
The answer is simpler than you think: Offer targeted and effective interventions – when preventing disease or treating it – at the point of care, in the office or out.
A good first step? Ensure you have the technology infrastructure to identify any obstacles to your success. Not sure what to look for or how to proceed? Consult the experts. It won’t take years to build (or replace) your technology foundation. It’s more accessible than you think.
Where can I find out more about ACOs?
- Learn more about how you can achieve ACO success
- Download our eBooks: ACO and Collaborative Care Solutions and Ten Tips for ACO Success
- Video: Crystal Run Healthcare was chosen by NCQA as one of six ACO early adopter physician practices. Hear from Gregory Spencer, MD, CMO about their ACO success.
- Take the next step to collaborative, accountable, quality care – reach out to NextGen Healthcare to learn more.