- Accountable care organizations are having difficulty developing and deploying successful population health management programs due to the underlying challenges of coordinating with community services and accessing the resources required to deliver holistic, coordinated care.
According to the first of two reports from the Premier Research Institute and the Robert Wood Johnson Foundation, only 32 percent of survey participants say their communities have adequate resources to partner for the population health improvements that form the foundation of value-based care.
“Alternative payment models, such as ACOs, serve to shift the traditional fee-for-service model, which incents providers to do more rather than do better, to a value-based model that aligns incentives with measurable quality, cost and population health outcomes,” said Timothy Lowe, PhD, director, healthcare research, Premier Research Institute, the study’s principal investigator.
“As providers develop and implement alternative payment models to align with value-based payment policies, such as the new Quality Payment Program for physicians, it is critical to identify what is working and what is not to support continuous change and improvement.”
For many ACOs, unfortunately, the list of what isn’t working is somewhat longer than the list of what is. Providers sharing their insights with the report’s authors cited a number of common obstacles, including data interoperability, financial pressures, concern over how to achieve ROI with population health management tools, and physician reluctance to embrace the value-based environment.
Gathering the buy-in, skills, and financial resources to address the social determinates of health also posed a major challenge to many of the 19 accountable care organizations participating in the survey.
Eighty-nine percent said they had trouble funding mental health programs, while 79 percent could not find room for all necessary social service programs in their budgets. Funding for substance abuse initiatives, housing, and public health projects also posed problems for ACOs.
Other barriers to population health management include difficulty coordinating care across disparate organizations (79 percent), health data interoperability issues (74 percent), low patient health literacy (68 percent), and transportation challenges that limit patient access to care (68 percent).
Accountable care organizations are also coming up short on adequate staffing to support patient-facing services such as chronic disease management and wellness education programs, transportation assistance, care coordination services, and telemedicine visits.
While 95 percent of ACOs would like to expand their behavioral health offerings, more than half of participants said they do not have the behavioral health providers and care managers on staff to provide the required skills.
ACOs would also like to increase the availability of transportation services (79 percent) and prescription assistance (74 percent), as well as substance abuse programs, nutritional counseling, stable housing options, and literacy or educational initiatives.
While ACOs tend to believe that improving social wellness and behavioral health will translate to clinical and financial improvements for the healthcare industry, payers are hoping that providers channel their efforts in a different direction that may bring more immediate cost savings.
“Population health has come to mean managing transitions in care, managing quality metrics, and reducing hospital lengths of stay,” said one clinician participant in the survey during an interview with researchers.
“That definition has been basically forced upon us by the contracts that we have to do just those things as an ACO. It has nothing to do with the true meaning of population health which is taking a population of patients and keeping them healthy.”
ACOs are deeply concerned with their financial performance, and use a variety of data sources and measures to gauge their success with the strategies that will return shared savings or help them avoid quality penalties.
Yet few ACOs believe that they are meeting their full performance potential. When asked to evaluate their success, forty-two percent said they perform “moderately,” and 16 percent said they were “challenged to perform as an ACO.” Only a third of respondents categorized themselves as high performers.
Some organizations may lack the advanced data analytics tools to access the actionable insights required to view themselves as top-notch population health experts.
The majority use of respondents quarterly CMS claims data and monthly reports to gauge adherence to quality measures, yet only 47 percent are able to look at real-time clinical data related to the health status of their entire attributed population, and just 32 percent regularly review health indicators across the geographic area covered by the organization.
In their comments to researchers, participants cited infrastructure development as a particular pain point. ACOs containing providers with varying degrees of health IT maturity found it difficult to exchange data freely to coordinate care and streamline interventions, and many did not have the financial ability to help their less sophisticated colleagues purchase and implement the technologies required to identify and manage high-risk patients.
Overall, the report revealed deep frustration with inadequate resources and a fundamental tension between what clinicians feel is valuable to patient care and what tasks they must complete in order to meet their contractual obligations with payers.
“One of the things providers struggle with is they only have so much time,” a participant said. “There’s the balance between [wanting to] treat everybody the same versus [focusing] my limited amount of time on this person and what contract they’re in to maximize the performance of those [contracts] and to help that population.”
Clinicians and administrators participating in the project expressed a desire for increased alignment of goals and objectives, as well as more timely and robust data to allow them to address those needs with the limited resources available to them. In order to see success within the community – and with payers – ACOs must continue to develop strong relationships with community service providers and work to improve the flow of data that will support the delivery of quality care.