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Patient Experiences in ACOs: Real-Life Success Stories


Discussions about accountable care organizations (ACOs) frequently revolve around the financial side of the model – how to control health care costs by preventing avoidable readmissions; eliminating unnecessary tests; or encouraging patients to use lower cost care settings.

Achieving financial sustainability is a key goal in the shift from volume to value, but accountable care organizations, at their essence, have a higher goal: to improve patient outcomes and enhance patient satisfaction through coordinated care, that puts patients at the center of the decision-making process.

Patients may be unfamiliar with the term “accountable care organization,” but they are benefiting in real ways from the care they receive through ACOs. Here are two real-life stories of patients (whose names have been changed for confidentiality purposes) whose lives were changed for the better through communication, education, and appropriate clinical interventions.

Patricia: Understanding the Underlying Issues

Patricia is 36 years old and lives in Colorado. She has asthma as well as a chronic endocrine disease. After she had been to the ER three times in a six-month period, her ACO’s patient report flagged her for follow up intervention. A care coordinator reached out to discuss the situation, and learned that Patricia wasn’t satisfied with her primary care physician and was unaware of the services provided through urgent care, often a better option for her than the ER.

The care coordinator helped Patricia choose a new doctor, and explained the benefits of urgent care if she needed immediate attention. Patricia now sees her primary care doctor regularly, is managing her condition and recently avoided an unnecessary $2,500 ER visit. The care coordinator calls Patricia every other week, coaching her on how to manage her symptoms and avoid complications, and shares updates electronically with Patricia’s new primary care physician to optimize care coordination. 

Frank: Identifying a Better Plan for Care

Frank is a 45-year-old New Jersey man with Gaucher’s disease, a genetic disease condition that weakens the bones and increases the risk of fractures. Every month Frank had to travel 100 miles to an infusion center, where the cost of infusion treatments was $1.2 million each year. Luckily, the ACO’s pharmacy report pinpointed an opportunity for Frank to receive infusion services at home. Frank's primary care physician helped arrange the at-home care, offering him not only comfort and convenience, but a reduction in the annual cost of treatment by an estimated $675,000 a year.

Uncovering Opportunities for Better, Patient-Centered Care

When provider organizations are structured to act on situations before they escalate, patients win. Equipped with reporting tools designed to uncover opportunities for improved care, ACOs can empower patients in unstable or unsustainable situations, achieve significant cost savings, and ultimately drive better outcomes.