Care Coordination Vital in Accountable Care Organizations

November 10, 2016 - Healthcare payers looking to transition to new payment systems and better coordinate care across multiple facilities would benefit from working within accountable care organizations (ACOs). Within ACOs, payment is linked to quality performance and any savings obtained through accountable care systems can be shared among payers and providers.

However, payers should be aware that it may take more time to gain any major cost savings. Accountable care organizations participating in the Medicare Shared Savings Program share in more significant cost savings only after three years of operation. This means payers and providers need to be committed for a long period of time in order to succeed in an accountable care organization.

“It’s a hard journey and the quality goals for achieving and keeping savings are very high relative to fee-for-service,” Clif Gaus, the President and CEO of the National Association of ACOs, told HealthPayerIntelligence.com. “There’s two different standards here and learning to transform care and provide efficient and better quality takes time.”

“The ACOs have shown that, in the first three years, they’re able to improve the quality. They both provide higher quality and they’re quality-improving from year to year. That’s a home run. In some respects, that’s been the real success story of ACOs,” Gaus said. “The other side of that equation is the ACOs have to invest so much of their own money that without a quick return, they run out of money to continue. I believe that the ACO concept and model is still the best we have to lower costs and increase quality, but it can take a much longer time and needs greater rewards from the government to keep the movement growing.”

Large insurers like Aetna are investing in accountable care organizations to improve the patient experience and create value-based care contracts. In February 2016, Aetna announced it had partnered with the Delaware Valley Accountable Care Organization (DVACO). The two organizations are looking to improve the quality and efficiency of medical services while boosting population health management and care coordination.

One study published in the Journal of the American Board of Family Medicine discusses why care coordination is so necessary for managing a more fragmented healthcare system, supporting patients with chronic diseases, and lessening high healthcare costs.

The study outlines several key factors found in successful Medicare programs that were capable of decreasing costs. These factors are: targeting patients that would most benefit from care coordination, assessing the needs of patients, utilizing evidence-based clinical data to plan out health management strategies, and supporting patient engagement.

Also, accountable care organizations and other Medicare programs were found to be successful if communication between patients and clinicians was well-coordinated, transition between hospitals and post-acute care settings was addressed, and patient needs were met.

The study uncovers how meeting both social service and medical needs is key for strong care coordination, which means primary care offices will need to work outside their organization with community centers and other agencies.

However, payers and accountable care organizations need to be aware that primary care practices face challenges when attempting to address coordination between medical facilities and social service agencies. Often fee-for-service payment systems are inadequate for incentivizing primary care providers to work with those outside their facility, which means that payers should consider adopting alternative payment models if they are serious about improving care coordination.

Some other challenges providers face include a lack of training and little interoperability among electronic medical records. This shows that both healthcare delivery reforms and reimbursement changes are necessary among primary care practices in order to improve care coordination.

“To achieve the ‘triple aim’ goal of improving the health of communities, improving the care experience, and reducing costs, primary care practices will need to incorporate care coordination strategies into their practice,” the study stated. “Furthermore, as alternative payment and population health models such as accountable care organizations, managed care and bundled payments for episodes expand, primary care practices will have to use strategies to identify risk, coordinate information and patient preferences for care across settings.”

Payers will need to be aware that multiple payment models may be necessary to strengthen coordination and that a combination of community services and social support will be needed to assist high-risk patients. Yesterday’s fee-for-service payment systems will not be adequate to address care coordination between primary care practices, accountable care organizations, and community centers.

Dig Deeper:

What Are the Benefits of Accountable Care Organizations?

How Payers Should Prepare for Value-Based Reimbursement