6 Steps for Continued Accountable Care Organization Success
By - Accountable Care Organizations (ACOs) – collaborative clusters of physicians, hospitals, and other healthcare providers voluntarily uniting to offer better coordinated care – are spreading like wildfire within the healthcare realm. As new accountable care agreements between leading healthcare organizations emerge, so does discussion about their alleged stability.
New focuses regarding the tightening of ACO initiatives naturally point to how to close noticeable gaps – operational, financial, communicative, reimbursement-related, and the like – to best succeed within both the short-term and long-term. To help assess where to begin with such evaluation and assessment, a whitepaper released by Athenahealth confirms 6 steps to accountable care organization success for healthcare organizations:
- Understand Your Costs
- Reduce Out-Migration from Your Network
- Maximize Pay-for-Performance Reimbursement
- Identify Early Opportunities for Utilization Reductions
- Support Chronic Care and Disease Management
- Predict Who Will Develop Issues
Making the healthcare insurer/payer connection
Within each of these steps is an outstretched variety of considerations. In conjunction with plans backed by the Centers for Medicare & Medicaid Services (CMS), commercial health insurers started offering risk-based contracts for healthcare providers, states Athenahealth. One of these programs, established as a payment reform model, prior to CMS’s initiatives, is the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC).
“While most commercial risk contracts include similar combinations of quality incentives, shared savings, or full capitation, and small budget adjustments for medical inflation, some have moved to partial capitation (bundled payments), retainer agreements, in-kind services and subsidies provided by payers, or have limited themselves to upside pay-for-performance incentives,” states Athenahealth.
“Operating as an MSSP or working with private payers does not require an exclusivity agreement, and many ACOs simultaneously contract with private payers and CMS. Additionally, many state Medicaid programs, either directly through the state Medicaid office or via a Medicaid managed care plan, are negotiating accountable care agreements with providers,” Athenahealth adds.
Athenahealth maintains access to payer claims-based data is imperative to help best comprehend the collective cost of care delivered by healthcare providers existing both within the ACO bubble and beyond. Access to payer claims-based data is also necessary to accurately attribute intervention spending for rendering providers, adds Athenahealth.
Maximizing pay-for-performance reimbursement is an additional needed area of focus, says Athenahealth. “Proper screening of and managing the primary health needs of a patient population saves money by keeping chronic diseases in check and by helping patients avoid expensive hospital or emergency room visits,” maintains Athenahealth, additionally confirming the importance for vendors to support an ACO with the needed tools and knowledge for comprehensively conducted reporting, tracking and benchmarking of financial and clinical performance.
ACOS: the good, the bad, the in-between
A myriad of opinions continue to evaluate the extent of ACO success and failure. ACOs are receiving a great deal of loud fanfare where the affirmation of associated successes are openly touted across the healthcare industry. For instance, Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS) recently confirmed, ACOs “are on the path towards transforming how care is provided.”
Opponents of ACO initiatives are indeed also alive and well, as RevCycleIntelligence.com reported. Those dubious of ACO success point to revenue cycle setbacks, mediocre financial performance, interoperability snarls, restrictive capital, and operational hindrances. Athenahealth, nonetheless, confirms ACOs are perhaps too new to tangibly assess with contemporary accuracy. Nonetheless, the ACO discussion continues.
