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Getting Started With an ACO: Small Wins That Can be Expanded Over Time

Accountable Care Solutions

In the past two years, more small and medium size provider organizations are moving to value-based care models. Initial steps include identifying, prioritizing and rolling out new clinical programs relatively quickly compared to larger health systems.

  • Smaller accountable care organizations (ACO) often promote value-based care through a lean team of 3-5 experienced individuals. These teams become dedicated solely to the success of the ACO. A few of the most critical key team members include: A clinical leader who can inspire, engage and influence providers to buy into the ACO. This leader must connect with the patient community and explain the vision of the ACO. He or she must describe how a patient’s health will improve through value-based care.
  • A program manager with strong  implementation experience and communication skills
  • One seasoned analytical and/or actuarial resource
  • One seasoned report writer with deep data management skills
  • An experienced resource with deep IT, data governance and electronic health record (EHR) knowledge

 

Health care organizations can achieve small wins with the right resources

ACOs need to make fairly significant investments in technology platforms. Immediate wins can be achieved prior to having complete automation. Strong commitment from senior leadership is critical to the building blocks of an ACO. These building blocks include the launch of clinical programs, such as palliative care, complex care management and transitions of care programs.

In some instances, we have seen a compassionate care program launch with one or two skilled individuals. These individuals help identify the patients who are very sick and provide the patients with the most appropriate and coordinated care.

We are also seeing organizations move away from a traditional case management model by embedding resources into their emergency department (ED). These resources help with the following tasks:

  • Streamline administrative processes
  • Educate patients
  • Coordinate follow-up appointments
  • Provide assistance with the transition from inpatient to outpatient status

While technology plays a large role in the transition to value-based care, providers do not need to implement the most sophisticated and complex platforms right away. Supported by tools and solutions, a hospital can access clinical data from its EHR system to identify patients with multiple co-morbidities. These are patients who might share one complaint in the ED, but also have other issues. With the right process in place, a team of 2-3 people can intervene and direct more coordinated, higher quality care for patients.

 

ACOs of different shapes and sizes all share a singular vision

An ACO is generally formed with large hospital systems. However, according to Kaiser Health News, “more than half of the current Medicare ACOs are actually run by physicians and don't include a hospital partner.”

We’ve seen many smaller organizations achieve success in a value-based care model, including a 300-person physician practice group and a small community hospital.

Both organizations succeeded due to the dedication and vision of their leadership teams. In any size ACO, leadership plays a key role. These leaders help:

  • Facilitate change management
  • Obtain physician buy-in
  • Provide the vision for total population health management

The key to getting started in an ACO is not just about changing business models alone. It is also about sharing the vision of a new approach to educating and caring for an entire community. This helps families stay healthy longer, by promoting a health care system where payers and providers collaborate to improve overall population health.