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A Tale of Two Patients: ACO Cost Savings and Mental Health Support

Accountable Care Solutions

Frequently, patients dealing with new or existing health challenges are unaware of the range of resources available to them. In the absence of information, they try to go it alone. Things may start to unravel, causing even more distress.

Accountable care organizations (ACOs) are designed to help patients address problems before they escalate. In Part One and Part Two of our series looking at ACOs from the consumer perspective, we met four patients who were able to get, and stay, on track through targeted interventions.

Here you’ll meet two more patients, Janice, a 51-year-old woman suffering from chronic pain, and Robert, a 59-year-old man with peripheral vascular disease (names have been changed for confidentiality purposes). Their stories demonstrate the value of a coordinated, holistic approach to patient care that leads to better outcomes, an improved experience and lower costs.

Janice: Avoiding An Unnecessary Trip to the ER

Most people don’t want to spend endless hours in the emergency room (ER). But if you aren’t aware of other appropriate options for treatment, that’s where you’ll go. That’s what happened to Janice. Fortunately, Janice is a member of an accountable care organization. After her second trip to the ER this year, she was identifed in an ACO monthly report. The ACO case manager, a registered nurse, immediately reached out to Janice to provide her with support and suggested that she could benefit from participating in a case management program. Janice agreed, and things began to improve:

  • She is managing her pain.
  • She is aware of her options for care.
  • She is able to continue performing her job duties.
  • She avoided another trip to the ER – a savings of $2,150.

Robert: Coping with a New Diagnosis – And Depression

A new diagnosis often carries an emotional payload, making it even harder for a patient to manage the primary condition. Robert was struggling with pain and circulation issues after a hospitalization for peripheral vascular disease. On top of that, he was fighting depression.

The ACO case manager, a registered nurse, understood that a holistic approach was essential to helping Robert succeed. He needed access to a behavioral health provider to address his depression, and education to manage his condition. The care coordinator worked with Robert to help him understand his condition, medications and pain concerns, and introduced him to a mental health provider. The two-pronged approach has helped Robert succeed on both fronts:

  • He is meeting with his mental health provider regularly.
  • His mood has improved and his pain concerns are being addressed.
  • He will soon be graduating from the case management program due to his success.

The potential of accountable care organizations to improve outcomes and the patient experience by proactively managing patient populations is just beginning to be realized. Traditional models, characterized by a reactive, siloed approach to patient care have resulted in high costs without associated improvements in quality. They are giving way to new models, as these stories of patient empowerment and success demonstrate.