Accountable care organizations have been getting some attention, thanks to health reform, but how the heck do you build one?
The Commonwealth Fund released a new white paper on lessons learned from members of the Premier healthcare alliance's accountable care collaborative. Commonwealth researchers say while attention has been paid to the public policy around ACOs, there's been less focus on the organizations that are building, testing and bringing to scale new models of care delivery.
Researchers offer the following steps to develop an ACO model that can be replicated by hospitals, health systems and physician practices:
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Many different organizational models could work for ACOs. It is not necessary for an ACO to be a single, co-owned entity, or for providers to "own" their ACO networks.
ACOs must align business with value-based payments. Working under shared savings and a fee-for-service payment system creates parallel business models. It is essential to align payments quickly to move toward value-based care.
Leaders need to design collaboration incentives. Physicians should receive incentives to deliver high-quality care based on pre-defined measures, but they must be able to influence the approach.
ACOs need financial modeling to assess economic impact. This helps set appropriate targets for short- and long-term budgets and supports evaluations of payment options, including the two Medicare Shared Savings Program tracks, capitated payments and private payor arrangements.
Extensive investment in HIT is needed to coordinate care. Providers need seamless coordination with sophisticated population health status measurement to improve health and reduce costs.
ACOs must measure performance on a broad range of measures. ACOs require aggregated data on utilization, demographics, financial performance, quality scores and other metrics at least quarterly. This information must be linked across the continuum to support predictive modeling, targeted services, provider evaluations and patient interventions. Reports need to be relevant, presenting information in a digestible, actionable format.
"By emphasizing wellness and prevention, and facilitating clinical integration across all providers with people at the center, ACOs will improve population health," says Susan DeVore, Premier president and CEO.
"But it won't be simple. Deployment requires operational and technological capabilities, combined with good partnerships that span the care continuum. Success in these new delivery models will offer a dramatic shift in the financing and delivery of health care, a change that will touch virtually everyone providing, receiving or funding it."
Premier, a provider-owned alliance of more than 2,600 U.S. hospitals and 86,000-plus other sites, operates the nation's largest performance improvement care network.
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