- With value-based care reimbursement becoming the standard across health insurance companies and medical facilities around the country, stakeholders are investing more time and resources in accountable care organizations (ACOs). Why should healthcare payers partner with accountable care organizations? What are the key benefits for payers and their members?
Better quality of care
According to a Premier Inc. press release from November 2016, accountable care organizations part of the Premier Population Health Management Collaborative (PHMC) had better quality of care and cost reduction results than ACOs operating through the Medicare Shared Savings Program (MSSP) in 2015. While 31 percent of MSSP accountable care organizations and Pioneer ACOs qualified for shared savings, half of all ACOs operating through the Population Health Management Collaborative qualified for shared savings.
Nonetheless, ACOs operating under the Medicare program have also shown improved quality of care when qualifying for shared savings. A Health Affairs study shows that accountable care organizations that earn shared savings have somewhat better quality scores at 93 percent when compared to ACOs that did not earn shared savings with scores at 91 percent.
Greater use of preventive services
Accountable care organizations have focused their efforts on increasing the use of preventive care and chronic disease management to reduce the utilization of expensive acute care services. For example, the Great Lakes Organized System of Care has worked on improving patient outreach to ensure more preventive services are integrated in their patient care.
To better manage public health, accountable care organizations will need to incorporate health IT tools and implement medical data exchange protocols. Additionally, ACOs will need to incorporate preventive care in order to succeed in population health management, said Lori Dale, Executive Director of Great Lakes Organized System of Care.
“When you’re talking from an ACO perspective, we are still in the early stages, but we do multiple things for prevention,” Dale explained. “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 added. “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.”
ACOs enhance diabetes management
The American Journal of Managed Care (AMJC) published a study that finds accountable care organizations could better reduce the high costs of diabetes treatment and assist patients in managing diabetes by incorporating self-management education. ACOs and primary care centers can use Diabetes Self-Management Education to teach patients to incorporate a healthy diet, medication management techniques, physical fitness, and disease monitoring.
Along with Diabetes Self-Management Education, accountable care organizations could improve diabetes management by partnering with the YMCA, which operates the Diabetes Prevention Program.
“It turns out that YMCA’s Diabetes Prevention Program was shown to prevents new cases of diabetes 58 to 71 percent of the time in people with prediabetes,” Matt Longjohn, MD, MPH, and National Health Officer for YMCA of the USA, told HealthPayerIntelligence.com last November. “The reason why Medicare is covering this is because the science is clear. It helps people with prediabetes prevent new cases of becoming diabetic.”
Health insurance companies looking to benefit their member populations and reduce the high costs of medical care would benefit from partnering with accountable care organizations. ACOs have shown to lead to better quality of care, greater use of preventive strategies, and better diabetes management.