Value-Based Care News

Successful Accountable Care Organizations Use 3 Key Strategies

Transparency, physician leadership, and commitment are necessary for payers and providers to succeed in running an accountable care organization.

By Vera Gruessner

Health payers and providers who are seeking to form accountable care organizations will need to follow key steps in order to avoid the issues associated with these payment models and truly succeed in an accountable care environment. Below we outline three key strategies that payers and providers will need to incorporate when operating accountable care organizations.

Medicare Shared Savings Program

Tap into physician leadership

In an interview with Gregory Scrine, Managing Principal at healthcare consulting company Lumeris, the importance of physician leadership in running a successful ACO was discussed.

Designing the ACO with strong leadership governance is important since it will bring more engagement on the side of physicians who are key for meeting the many objectives of effective accountable care organizations, said Scrine.

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  • “Several criteria need to be met in order to set up a successful and workable accountable care organization,” Scrine explained. “The first core component is having the right organizational design and leadership governance. Physician engagement is key to the success of an ACO and, consequently, the efforts of setting up an ACO need to be physician-driven in order to achieve the desired results.”

    “Substantial physician participation and governance, including a majority of the board on a clinical-integrated network entity pursuing ACO activities is absolutely critical.”

    Ensuring the right legal organizational structure is also vital when forming accountable care organizations operating either through a private, commercial payer or through the Medicare Shared Savings Program.

    Set aside resources and fully commit to the endeavor

    Data from the Centers for Medicare & Medicaid Services (CMS) shows that accountable care organizations that have operated for several years have shown higher cost savings within the Medicare Shared Savings Program than those who are on their first year in the program.

    Accountable care organizations who’ve operated within the Medicare Shared Savings Program for three years had the greatest cost savings. This shows that more time and commitment is necessary to succeed in the accountable care model.

    After speaking with Aetna’s Vice President of Network and Product Strategy Accountable Care Solutions Amy Oldenburg, the results were clear that providers and payers will need to set aside resources and time to truly commit and succeed in the accountable care environment.

    “True transformation is a long-term endeavor,” Oldenburg told HealthPayerIntelligence.com.  “We know that it takes at least three years for motivated ACOs to make changes necessary to impact real savings and quality improvements.”

    “We believe transforming health care will help reduce waste, improve quality, improve member/patient satisfaction, and improve overall employee health and productivity,” Oldenburg pointed out. “So we see this as well worth the commitment and investment of time and resources to get there. Through our approach to move providers and hospitals toward full, product-based risk-sharing ACOs and helping them transform the way they do business, we know we can help build a healthier world.”

    Some of the types of resources that health payers and providers will need to incorporate include analytics tools, especially those adhering to quality metric protocols. Using these tools will help providers identify any gaps in care while also incentivizing physicians to adhere to quality care benchmarks.

    Ensure strong transparency and data sharing

    In order to succeed as an accountable care organization, payers and providers will need strong cost transparency when initiating ACO contracts. Both parties will need to be satisfied with the measures of an accountable care contract and the reimbursement protocols as well.

    The way accountable care organizations work is by coordinating care among specialists, primary care doctors, hospitals, and urgent care centers. In order for payers to operate a prosperous ACO, data sharing will need to be incorporated between all of these medical facilities and health insurance representatives. Once again, this means that the right tools and electronic health records will need to be incorporated and interoperability supported throughout the network of providers.

    Health payers and providers who meet these three measures for operating accountable care organizations are likely to succeed over time and garner cost savings for their establishment.

     

    Dig Deeper:

    Top 3 Ways Accountable Care Organizations Could Garner Savings

    How to Strengthen Accountable Care Organizations, MSSP