Value-Based Care News

How ACO Providers Could Integrate Specialty Care with PCPs

Researchers from the Deloitte Center for Health Solutions interviewed providers participating in an ACO on their perspective regarding specialty care.

By Vera Gruessner

- Healthcare providers and payers working together to develop an effective accountable care organization (ACO) and a strong contract will need to consider the importance of including specialty care, an article from the Health Affairs publication reports.

Accountable Care Organization

In particular, ACOs need to meet quality performance scores as well as cost saving goals, which makes integrating specialty care key. A large part of healthcare spending and total medical care is managed by specialists such as surgeons and rehabilitation medical workers who assist in both inpatient and outpatient settings.

For example, pediatrics, primary care clinics, and internal medicine accounted for only 30.4 percent of healthcare spending in 2009, which shows how specialty care is utilized in much larger numbers by patients and families.

Researchers from the Deloitte Center for Health Solutions interviewed a number of providers participating in an accountable care organization on their perspective regarding specialty care and how to better integrate it within an ACO.

  • CVS Health Invests $2.5M in Tobacco, Opioids Substance Abuse Care
  • Top 3 Difficulties Facing State Health Insurance Exchanges
  • Administrative Plan Costs for Managed Care Payers Jumped 5.7% in 2017
  • The interviews showed that providers have not completely changed practice patterns as of yet but, instead, have worked on “influencing referral patterns and care management around specialty care.”

    One ACO has focused on gathering data and exchanging information with primary care physicians to further encourage a discussion around changing practice patterns. Additionally, the accountable care organization has brought more focus toward population health management and the development of patient-centered medical homes.

    The report from the Deloitte Center for Health Solutions also found that engaging primary care physicians in redesigning their healthcare processes and workflows could help improve the functioning of an ACO. For instance, bringing team members from various departments together in quarterly meetings could lead the ACO to meet its quality performance goals.

    The way ACOs seem to be tackling high healthcare costs is by targeting medical conditions that lead to larger rates of hospitalization and readmissions such as cardiovascular issues. In particular, greater health information exchange through health IT platforms and strong care coordination among team members is a main pathway toward meeting ACO quality measures.

    In particular, the report encourages ACO providers to leverage data to determine how to improve practices, lower costs, and boost quality. For example, when one ACO looked at orthopedic surgical rates between their different medical practices, they found a wide amount of variation particularly in referral rates. They were then able to target referral rates to improve the quality care among their orthopedic surgery settings.

    April Wortham-Collins, Senior Analyst at Decision Resources Group, spoke with RevCycleIntelligence.com about how certain benchmarks in measuring ACO quality may actually lead to little reward if the accountable care organization succeeds “year after year.”

    “The conversation [in 2016] will lead to the idea of benchmarking and how the baseline for ACO Shared Savings is set, whether it's prospective or retrospective assignment of ACO beneficiary. And how to get past this unintended consequence with the Pioneer, and the early Medicare Shared Savings Program,” Wortham-Collins explained.

    “The best ACOs were penalized for doing good work. As they improved their performance in year two, in year three of their contracts, their shared savings payments were getting smaller.”

    “CMS recognizes there's an issue there, and they're working to correct that. It's a very complicated and complex thing to sort out. It can be market-dependent, it can be ACO-dependent, on how you set those benchmarks.”

    “My one message is with what we're seeing in terms of growth trends and the general future of ACOs combined with CMS announcements on MSSP ACOs and the Next Generation is recognition there's not a one-size-fits-all model for accountable care,” Wortham-Collins concluded.

    “We are going to have to learn, make some mistakes, experiment, and innovate to the point where we can figure out what works best for which populations in which markets.”