Value-Based Care News

How Accountable Care Organizations Use Preventive Services

Various accountable care organizations have brought better quality reporting and improved health outcomes to their patient base.

By Vera Gruessner

What accomplishments have accountable care organizations (ACOs), providers, and payers reached in their effort to operate value-based reimbursement systems? This is the question that many ACOs are answering today.

Preventive Healthcare Services

With value-based care reimbursement becoming a mainstay of the healthcare industry and more hospitals and health plans transitioning away from fee-for-service payment structures, it is no surprise that new models of care such as patient-centered medical homes and accountable care organizations are becoming more popular across the country.

Various accountable care organizations have brought better quality reporting and improved health outcomes to their patient base. This may include the use of extended doctor’s office hours, the inclusion of reminders sent to consumers to obtain preventive screenings or wellness visits, and even patient orientations throughout a clinic or physician office.

The Great Lakes Organized System of Care is one ACO that has done patient outreach to stress preventive services, improved the rate of cancer screenings, and worked toward reducing hospital readmissions. Lori Dale, Executive Director of Great Lakes Organized System of Care, offered more detail in an interview with HealthPayerIntelligence.com.

“Blue Cross and Blue Shield started a patient-centered medical home 10 years ago and it’s been a building block to become successful in the value-based world and to help prepare providers for risk,” Dale said. “In our practices, they either have a Medicare Blue Cross and Blue Shield secondary payer mix or it could be switched from strong Blue Cross and smaller Medicare market.”

Often, accountable care organizations bring focus to population health management and the Great Lakes Organized System of Care is no different. Population health management tools will be key for ACOs looking to succeed in their market, according to Anthony Vespa, Executive Director of South East Michigan Accountable Care.

“Population health management is critical.  Not only is it being driven by Medicare, Medicaid, and commercial plans, but it’s necessary for any organization to achieve scalability.  Without population health management technology, it would be impossible to work with your data.  You just wouldn’t be able to do it,” Vespa told HealthITAnalytics.com.

When it comes to improving and managing public health, healthcare data exchange and implementation of health IT tools will be necessary among all accountable care organizations. A greater focus on preventive healthcare services is also key, explained Dale.

“When you’re talking from an ACO perspective, we are still in the early stages, but we do multiple things for prevention,” Dale added. “Part of patient-centered medical homes, there are certain measures we put in place. One of those measures is to have open access for at least 30 percent.”

“We are doing outreach for preventive services such as mammograms, colorectal screening, and cervical cancer screenings,” she continued. “We use HEDIS measures. For instance, if a woman hasn’t had a mammogram in three years - we actually use a registry and it identifies those patients who have not had a mammogram - then we do patient outreach.”

Additionally, Dale spoke about how this particular ACO urges their physician practices to contact patients for their annual wellness exam. All of these efforts have led to a rise in the number of colorectal and cervical cancer screenings as well as the number of mammograms women receive.

“We have put care managers in our practices to help manage chronic conditions and do outreach. We are also using technology to identify patients who have been discharged from the hospital to complete transition of care visits. We call them within 48 hours of discharge and then we have the primary care practice see them within seven days,” Dale explained.

“Statistics show that 62 percent of all readmissions are associated with wrong medication,” she continued. “We’re hoping to reduce readmissions and bring better patient outcomes through medication reconciliation strategies.”

The healthcare industry is bringing more focus toward quality improvements and better health outcomes by positioning payers and providers to adopt value-based care payment contracts. This focus on value-based care reimbursement has spurred the need to meet quality metrics when operating accountable care organizations.

For instance, quality metrics could bring payers and providers to reduce the rate of hospital readmissions, which is one of the more costly aspects of healthcare spending. Cheri Bankston, Director of Clinical Advisory Services at Curaspan, mentioned the importance of automation technology when it comes to ensuring quality metrics end up in the hands of case managers and healthcare staff.

“How do I put this information about these quality metrics of the network in the hands of the case manager that sits at the bedside with the patient? We’ve done a lot at Curaspan to try and automate that process,” Bankston told HealthPayerIntelligence.com. “What we’re able to do is provide metrics on the individual provider performance. We recommend looking at things like the provider response time for referrals, acceptance rate, readmission rate, and the CMS star ratings.”

Lori Dale continued describing how value-based care has made an impact on the cost and quality of the Great Lakes Organized System of Care. In fact, the rate of more costly emergency room visits has decreased due to their focus on value-based care and quality metrics.

“We look at value-based care in terms of cost and quality,” Dale said. “Since we’ve been focusing on our preventive testing to get patients in, we’ve seen significant increases in the number of cancer screenings and a decrease in our emergency room utilization. I pride our primary care practices on that. We focused on that two years ago.”

“It is really not good patient care to have them continue to go to the emergency room for things that are not emergent,” she added. “We focused on how to keep our patients from going to the emergency room. Our physicians have extended their office hours so that patients could get in right away for urgent issues. Practices have worked hard at educating patients on the pitfalls of going to the emergency room when it’s not an emergency.”

This has also led to greater patient satisfaction throughout this accountable care organization. With more office hours and more time spent on direct patient care, the end-consumers can connect with their physicians more deeply and truly create a stronger relationship that will benefit their overall health.

“We’re really trying to loop our patients back into their care,” she concluded. “That is a challenge. We are trying to get patients re-engaged and having them accountable for their care. For so long, patients have been used to whatever the doctor says but they didn’t think about their care. In our value-based world, the patients themselves takes more accountability for their diet, exercise, and understanding what medications they’re taking and why."

 

Dig Deeper:

Accountable Care Organizations Rely on Population Health Data

How Payers Should Prepare for Value-Based Reimbursement