Healthcare Analytics, Population Health Management, Healthcare Big Data

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ACOs Focus on Health IT, Population Health Management Plans

Accountable care organizations are building up their population health management competencies through care coordinators and increased health IT adoption.

Accountable care organizations and population health management

Source: Thinkstock

By Jennifer Bresnick

- Trimming costs by implementing coordinated, high-touch population health management initiatives is the primary focus for the majority of accountable care organizations (ACOs) responding to a new poll conducted by National Association of ACOs (NAACOS) and Leavitt Partners.

The survey, which collected responses from 240 ACOs participating in a variety of value-based care and risk-sharing arrangements, showed that most organizations are aggressively pursuing chronic disease management programs, care integration strategies, and patient engagement techniques that will help to reduce costs and improve the quality of care.

“In the short time that accountable care organizations (ACOs) have formally been a part of the health care landscape, they have grown to cover more than 32 million patients across every state in the country,” wrote the survey’s authors as they shared the survey’s results in a blog post for Health Affairs.

“Understanding where ACOs are focusing their resources shows how ACOs are preparing for their intended future risk-bearing.”

That future is likely to include more financial responsibility for outcomes bound up in a greater number of contracts with Medicare, Medicaid, and private payers, the survey found. 

READ MORE: Top 10 Challenges of Population Health Management

More than two-thirds of ACOs that include both hospitals and physician organizations have already put at least a portion of their shared savings at risk, with 35 percent of hospital-based ACOs and 52 percent of physician ACOs considering or planning to participate in the near future.

Risk-sharing structures of accountable care organizations

Source: Health Affairs / NAACOS / Leavitt Partners

Naturally, up-side risk sharing remains much more popular than two-sided risk arrangements, but new options from the Medicare Shared Savings Program and MACRA’s APM structure are attracting a great deal of interest from ACOs that are starting to feel comfortable with value-based care.

Most organizations are also dabbling in several different alternative payment model programs, the survey added. 

Patient-centered medical homes (PCMHs) are among the most likely to take on a variety of different contracts, with 77 percent stating that they are already participating in at least one other innovative model.

READ MORE: Big Data, Population Health Management Make Successful ACOs

Thirty percent of organizations undertaking the Comprehensive Care for Joint Replacement (CJR) program and 22 percent of ACOs in the Comprehensive Primary Care Plus (CPC+) initiative have also undertaken multiple value-based care efforts.

In order to ensure shared savings or bonuses from these payment structures, ACOs are exercising their population health management muscles to reduce gaps in care, track patients across the care continuum, and avoid costly crises events.

Medication management and reconciliation services are a popular way for ACOs to reduce the likelihood of patient safety events. 

More than 65 percent have already implemented medication reconciliation services during outpatient visits, although just 20 percent have put pharmacist-directed medication adherence programs in place.

Population health management competencies of ACOs

Source: Health Affairs / NAACOS / Leavitt Partners

READ MORE: How to Get Started with a Population Health Management Program

Chronic disease management programs are also top of mind for ACOs, with more than half stating that they have already put these strategies in place.  An additional third of respondents have partially implemented these competencies, while the remaining 10 percent have plans to do so.

Care coordinators are integral to these efforts.  Close to 90 percent of respondents stated that these patient navigation experts are very or extremely important to the success of the ACO, with one participant stating that coordinators are the “glue connect[ing] a disjointed care delivery system.”

Care coordinators deliver patient education, encourage engagement, and contribute to the efforts to prevent hospital readmissions currently underway at close to 60 percent of ACOs.

“ACOs are increasingly using care coordinators as connectors—identifying patients’ needs and ensuring a warm hand-off with the appropriate ACO or community resource,” the authors wrote.

Coordinators have taken on a broad range of roles, including conducting medication reconciliation, overseeing family and caregiver relations, undertaking post-discharge and post-acute care follow-up tasks, placing reminder and education calls, and working with community resources to connect patients to services addressing socioeconomic needs.

The work of these coordinators is supported by a number of different health IT tools, although ACOs have room to grow in the technical arena.

“ACOs are increasingly using technology to equip clinicians with information to inform their care delivery practices,” the study notes, yet “ACOs reported spending an average of $600,000 on operating expenses for health IT, analytics, and reporting, which is relatively low compared to the reported average investment of $1.1 million on care management.”

Health IT tools in place at accountable care organizations

Source: Health Affairs / NAACOS / Leavitt Partners

Eighty percent are utilizing some form of population health analytics, the survey found, while 60 percent are connected to either a state or regional health information exchange (HIE).  Just 56 percent are using decision-support tools, however, and a mere 40 percent have electronic medication reconciliation capabilities.

On average, providers comprising each ACO use 13 different EHR platforms, which may complicate information exchange and the extraction of big data for analytics, quality benchmarking, and performance profiling.

Respondents also reported using a number of different patient portal technologies, presenting possible complications for patient who seek care at multiple sites within the same ACO.

Overall, accountable care organizations appear to be relatively well-equipped with health IT tools to help them meet their primary goals.

At the top of the priority list is cutting costs, which coincidentally also ranked first among the organization’s greatest challenges.  ACOs intend to reduce spending by focusing on preventing admissions, readmissions, and avoidable ED visits for the remainder of 2017.

Improved data analytics and reporting to help better manage chronic diseases, coordinate care, and reduce practice variation are also important intertwining goals for these organizations as they explore additional risk-based payment structures.

“There are continued opportunities for other policy makers, researchers, and stakeholder organizations to study and support the ACO movement,” the survey concluded. “It will only be through the shared learning and collaboration of health care stakeholders across the industry that ACOs and other providers can sustainably adapt.”

“More aggressive care delivery changes, including integrating behavioral health and optimizing medication management, may be necessary for ACOs to achieve their stated goals of reducing costs and improving quality. Policies and programs need to focus on facilitating the delivery transformation necessary to achieve the desired outcomes of payment reform.”


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