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Quality & Governance News

Accountable care requires outreach and a commitment to change

By Jennifer Bresnick

- According to a report released late last month, shared savings among Medicare’s accountable care organizations (ACOs) have topped $380 million in their first year of operation, and the network of above-and-beyond Pioneer ACOs are responsible for just under half of that significant haul.  With a focus on accountable care, population health management, and the use of data analytics to generate actionable insights and predict trouble spots for patients, ACOs represent the future of a healthcare industry geared towards patient-centered care and provider-centered savings.

As one of two Pioneer ACOs receiving special commendation in the CMS report, the Heritage California ACO has a lot to be proud of.  Mark Wagar, President of Heritage Medical Systems, spoke to HealthITAnalytics about some of the program’s successes and the challenges it faced during its early days as a transformative force among Southern California providers.

How can providers find ways to trim costs through the ACO model?

The greatest opportunity for savings is proactive intervention and improvements in health status before peoples’ health issues get to the point where they’ll actually need significant intervention. The majority of the savings come from outpatient services and other activities, and you also see some savings from inpatient activities.  So, I still think there’s more savings to be had.  And if we’re able to work with patients to improve their health status, we’ll be avoiding more admissions, too.

What were your biggest challenges when you were starting out?

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In our first year, in particular, engaging our Medicare-aged patients was one of the biggest challenges, because you have thousands and thousands of seniors who were informed they were part of an accountable care organization effort, but they really didn’t understand what that meant.

So, a lot of our work this past year involves having people reach out, meet with the seniors in person, and explain we are an organization that’s working with their physician’s office.  It’s not instead of their physician’s office.  We’re just able to provide additional services that their physician’s office wouldn’t otherwise be able to provide directly.  And once they understand that, it’s a helper for their relationship with their physician.  They’re much more willing to engage.  And that’s one of the first-year challenges.  Now, with these results in the latest CMS report, what you’re seeing is the value of being able to communicate with those senior members, because you’re seeing the results here.

What kind of services can you provide to patients and their physicians?

Very often for these patients, it’s not their fault that they have lots of issues impacting their health and their life, but they need help sorting it out.  So, that’s why when you hear about us doing things like home visits, we’re involving all kinds of practitioners.  You want to know their social circumstances, not just on medical circumstances, because oftentimes their economic and living situation or family situations impact their ability to improve their health status.  You have to know all those things.

Also, we have to work with the physicians to acquaint them with their obligations and responsibilities, and help their offices and their office staff understand the additional capabilities we bring.  If you’ve got patients that are assigned to you that you haven’t seen in a long time, we’ll help get them an appointment.  We’ll reach out to them.  We’ll help you get the additional tests and evaluations done that you need to fully engage with them and make sure that they are in optimum health status instead of waiting until they’re too ill and finally coming to see you.

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What should providers consider before joining an ACO?

If you’re going to participate in an ACO, you want to make sure that your practice has decided that it wants to change.  You may be doing the best that you can with the tools that you have, but you have to be a practice that’s not satisfied with the status quo.  You need to believe you can do more.  This is not for practice that just says, “Well, I’ll sign up and I’ll get a bonus every year just doing what I’m doing.”

So, assuming you’ve committed to that, you need to take a look around your own practice and do an assessment.  What are the key things that you want to be able to do with your patients?  What can you do on your own, and what do you need a greater investment to accomplish?  Once you know what’s within your grasp and what isn’t, you need to find a partner.  Heritage is exactly that.  When we work with our physicians in the Pioneer model, we’re effectively providing the same level of proactive engagement that we would were you involved with a Medicare Advantage HMO or what have you.  You have to do the same kinds of things to show results.  At this stage, we’ve been able to show some of that.


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