Accountable care organizations are heading towards new level of danger and reward, and to succeed, they will require relying heavily on IT, specifically the use of analytics.
The CMS (Centers for Medicare and Medicaid Services) recently declared participants in the new program, naming 21 agencies that will be testing the waters of the Next Generation Accountable Care Organization (NGACO) model.
Those agencies have already acquired experience with ACO initiatives, either through the Medicare Shared Savings Program or the Pioneer ACO model. It is obvious that the models are challenging and that contributors have had mixed outcomes with ACO initiatives; for instance, about half of the 32 accountable care organizations that were in the original Pioneer ACO program have dropped out, significantly due to financial issues.
Through the future generation ACO program, CMS will partner with ACOs that have experience in coordinating care for populace and whose contributor groups are ready to consider higher levels of financial threat and reward. CMS sates that it wants to utilize the program to provide beneficiaries benefit enhancements, while offering ACOs better economical support, in hopes of constructing a model that will be sustainable over the long term.
ACOs are intended to better coordinate care for patients, while improving the partnership between patients and doctors in making healthcare decisions. For providers, ACOs hold the promise of realigning the practice of medicine with the ideals of the profession—keeping the focus on patient health and the most appropriate care.
The challenges of ACO models, and particularly the new model, will place a greater emphasis on the use of information technology to aggregate and coordinate patients' care delivery, and analytics to effectively segment populations for care.
The stakes are high with ACO approaches. For instance, Beacon Health, the ACO of Eastern Maine Healthcare Systems, engaged in the Pioneer ACO program for 3 years. Beacon Health made money in Year 1, lost money in Years 2 and 3, and opted out of Year 4, stated Jeff Sanford, CEO at Beacon Health. "You can be victorious in lowering prices and raising quality, and still not succeed in that financial model," he claims.
Even so, Beacon Health now will participate in the Next Generation ACO Model. Better prospects of doing well economically are a huge part of that move. But to win in the Next Generation ACO model, Beacon Health is raising its technology game, specifically by increasing its use of data analytics.
The Next Generation ACO program involves provisions for increased shared savings, but also more threat for the ACOs. The agencies can share in 80% of the savings or losses, compared with 60% to 75% initially under the Pioneer ACO program. Although, Sanford considers the program offers a better opportunity at being rewarded than it did under the Pioneer ACO program. Because Beacon Health already has cut prices and improved quality, the organization considers it can succeed as a Next Generation ACO.
The Next Generation ACO program involves provisions for increased shared savings, but also more threat for the ACOs.
Under the Next Generation ACO model, making certain patient risk scores are suitable will play a greater role than it did for Pioneer ACOs, and that is now a concentration for analytics work at Beacon Health. If a sufferer had a high risk score in the years 2013 and 2014, the organization can consider it is still high in the years 2015 and 2016, Sanford states. As a result, Beacon Health will make great use of analytics and other population health IT to identify these sufferers and ensure they still are acquiring continuity of care, Sanford further adds.
It is also crucial to educate primary care physicians and staff on the significance of making certain that entire diagnoses and other health problems in the population are being dealt on an annual basis, he adds. That will fall to administrators and care management staff in case for Beacon Health to reach financial objectives under the ACO.
Beacon Health initially outsourced analytics, considering that the company with which they contracted had the suitable levels of expertise, knowledge and economies of scale. The partner, it turns out, could offer merely high-level summary data when the agency required detailed actionable data, Sanford claims. Beacon Health was not satisfied with outcomes, so it brought analytics in-house in the month of June 2015.
Beacon Health is sustaining to build up its IT resources. Among other problems, analytics can recognize where emergency department utilization is high, and whether the similar patients and contributors contribute to overutilization. It also now knows how many sufferers are treated in the emergency department, treated in the hospital or sent home, and it compares its partner hospitals to determine why some are admitting more sufferers than others.
Beacon Health also is doing few remote monitoring of chronically ill sufferers in their homes, but would like to do more, Sanford states. "It’s simple technology and a great way of keeping track of sufferers." The agency is testing remote monitoring with cardiac sufferers and soon will expand the program to sufferers who have diabetes and respiratory diseases.
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