Plotting the ACO roadmap: Focusing on care first and foremost

To manage populations effectively, care teams must determine what motivates a patient to change behavior.
By Mike Lovett
08:45 AM

It's a brave new world in healthcare, and emerging value-based care models are introducing many "firsts" to the industry. More specifically, ACOs are requiring two key stakeholders--providers and patients--to partner in novel ways to shift the paradigm from fee-for-service to quality-driven care. Although many factors contribute to the big picture of ACO operations, the basics of a sustainable strategy boil down to how organizations bring together patients, providers and technology to move the needle on patient outcomes.

As discussed in the first article of this series, providers must be committed to business transformation that supports data-driven, proactive care delivery. Article two demonstrated the importance of patients partnering in their care, and the third installment made the case for leveraging technology to empower both providers and patients. While all these elements are important, organizations must push their ACO strategies further to realize true results.

At its core, an ACO is designed to elevate value and drive down healthcare costs. Even though risk-bearing arrangements give rise to the need for efficiency improvements and other cost-saving measures, profitable ACOs understand that prioritizing patient care around outcomes improvement is the overarching strategy that delivers the greatest return.

Emphasizing focused care for maximum impact

Since every ACO is different, there is not one sure-fire way to approach this model--different patient populations and ACO goals necessitate different set ups. That said, there are some general steps organizations can take.

First, before entering a risk-bearing arrangement, an organization should fully understand the scope of care it will be called on to provide. To that end, it should establish a knowledge base about the projected population: identifying and quantifying the amount of chronically ill patients, individuals most at risk of reaching chronically-ill status and healthy patients. This first step is also a good test of the technology an organization is currently using and will give insight into the solutions they may need in the future.

Then, ACOs can work to design strategies that address the 1 percent of the population that's creating 30 percent of the care costs--zeroing in on chronic conditions such as COPD, congenital heart disease and diabetes as main priorities. Next, ACOs should think about methods for proactively managing those individuals at risk of moving up the severity ranks. Ultimately, these forward-thinking interventions will deliver the greatest result because organizations can intervene early, which is more cost-effective and keeps patients healthier.

As an ACO model begins to mature, clinical and financial leaders should also consider how to effectively define and prioritize quality measures. Medicare currently has 33 such measures related to ACOs, but not all of these are equally relevant in demonstrating an organization's success. For example, how patients rate a physician (measure #3) will not reveal whether an ACO is improving patient health. However, patient participation in a smoking cessation program (measure #17) can point to whether the model is having an impact. To fully appreciate whether an ACO program is working, organizations must pinpoint which metrics will be the most enlightening and make sure they reliably capture, report and respond to those. 

Equally critical to the ACO equation is a willingness on the part of providers to embrace advanced infrastructures that support the data analytics needed to manage risk. Amid all the moving parts of provider operations, the resources simply do not exist to sustain an ACO without technology--it's the main driver of executing ACO goals of improving overall patient care.

An evolving concept

The ACO idea continues to play out on the national stage as the industry works to overcome challenges associated with establishing the right metrics for measuring quality and value and payment. Surely the specifics of the ACO model will morph and change over time, but the core idea of structuring care to respond to the most at-risk patients and nurturing those that are not is a valuable and valid strategy. As the industry strives to connect best practices to outcomes measurement, providers should take appropriate steps to address patient care before cost. Focusing first and foremost on the patient and care quality will naturally progress into improved cost--both major goals of successful ACOs.

As providers design these models around a standard set of metrics, they may find that coordinated care delivery must extend beyond the basics of identifying at-risk populations and gaps in care. A more advanced strategy is characterized by the ability to drill down past the broad population demographics into the attributes of a particular patient. From a quality metrics standpoint, this measurement becomes much more abstract as it requires care teams to consider and respond to a patient's genetic nuances, socio-economic factors and lifestyles risks.

It is at this stage that true care transformation occurs, and providers are compelled to reconfigure operations to align with value-based care. To manage populations effectively, care teams must determine what motivates a patient to change behavior, shifting the focus of care outward to patients instead of inward on ACO models and technology approaches. Care teams will have to move outside the walls of a healthcare organization to help patients achieve their goals, and this will require providers to consider how to best allocate resources for proactive outreach.

When care delivery is designed around protocols defined by patient characteristics and the willingness to engage, the natural progression of care will lead to healthier populations and lower costs.