Establishing a Community-based Framework for ACOs

What is an ACO?

Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/

Accountable Care Organizations are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated, high quality care to their patients.

Post-acute Alignment

Hospital

Specialists

Disease Management Programs

PopulationHealth Analytics

Payer Partners

Primary CarePhysician

Patient Activation

What is an ACO?

Accountable Care Organizations provide the environment ideally suited to coordinate care across multiple providers who each share responsibility for patient health.

Whole Person CareCoordination

Primary Care

Behavioral HealthCommunity-BasedOrganizations

What is an ACO?

The ACO organizational structure typically incorporates three characteristics that define the ACO model:

2process-level mechanisms to help achieve desired outcomes

a structural realignment to enable process-level change

31organizational goals to reduce costs and improve health care quality

History of ACO Movement

The term “Accountable Care Organization” was coined by Dr. Elliott Fisher during a 2006 public meeting with the Medicare Payment Advisory Committee (MedPAC).

What is an ACO?

In order to improve quality and reduce costs, accountability for a patient’s care should be shared among all providers along the health care continuum

HospitalsHospitals WorkforceServices

Clinics Intellectualand Developmental

Disabilities

Chronic DiseaseManagement

HousingServices

BehavioralHealth

Youth and Family Services

Growth of ACOs

Source: Muhlestein, McClellan. Accountable Care Organizations In 2016: Private And Public-Sector Growth And Dispersion. Health Affairs Blog. 2016, Apr 21

ACOs

2012 2016

838

157

Lives Covered

2012 2016

7MILLION

28MILLION

Community-basedMedicaid ACOs

Community-based Medicaid ACOs

Community-based Medicaid ACOs combine primary and behavioral healthcare with community-based providers who address the social determinants of health for vulnerable populations

Whole Person CareCoordination

Behavioral HealthCommunity-BasedOrganizations

The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

Source: World Health Organization

Social Determinants of Health

Social Determinants of Health and Accountable Care

Understanding the social determinants of health are crucial to healthcare delivery that seeks to both improve outcomes and reduce cost.

Housing/Homeless

Service

Safety Youth andFamily Services

DisasterRecovery

Intellectual andDevelopmentDisabilities

BehavioralHealth

Long-term Supportand Services

Chronic DiseaseManagement

Three key componentsof a community-based ACO�

PaymentModel

QualityMeasurement

Data AnalysisStrategies

PaymentModel

MEDICAID ACO PROVIDERS

• Share financial risk through a shared savingsplan

• Are compensated with financial reward forachievements based on quality measurementand improvement

QualityMeasurement

ACOs must carefully define a set of quality metrics that reflect the unique needs of their Medicaid population

ReducedED UTILIZATION

DecreasedHOSPITAL READMISSIONS

ImprovedMANAGEMENT OF

CHRONIC DISEASES

COMMON QUALITY INDICATORSMEDICAID ACOs MONITOR IN THEIR

PATIENT POPULATIONS

QualityMeasurement

• States use a variety of quality metrics to access ACO outcomes, including:

– Statewide averages of other healthcare providers' performance

– Performance of other ACOs

– Performance of other programs, such as the Medicare Shared Savings Program

• Provider payments are tied to these quality metrics

• Providers typically will not receive a portion of shared savings if they exceed or do not meet quality benchmarks

Data AnalysisStrategies

• Medicaid ACO’s require substantial data totrack patient utilization data and costs

• Timely and accurate collection and analysisare essential to operation

• Data can also be mined to identifyopportunities to improve care managementefforts

State MedicaidACOs

• Individual states developstate-specific ACO modelsbased on each state’shealthcare landscape

• As of September 2016, tenstates have launchedMedicaid ACO programs

According to the Center for Healthcare Strategies, “States have been actively pursuing innovative care delivery and payment models in order to improve the capacity of the health system to deliver high-value care and increase

provider accountability, particularly for high- need populations facing multiple

health challenges.”

Although state and regional Medicaid ACOs are a relatively new development, they have already demonstrated some

impressive results

COLORADO’S REGIONAL CARE COLLABORATIVE ORGANIZATIONS REPORTED

$139MILLION

net savings for Colorado Medicaid since FY 2011-12

$205MILLION

avoided medical costs in FY 2015-16

RCCOs have demonstrated lower rates of:

emergency department (ED) visits

high-cost imaging

hospital readmissions for

adult patients

for adult patients who have been enrolled in the program for more than six months

MINNESOTA’S INTEGRATED HEALTH PROVIDER PROGRAM

$76.3MILLION

Within it’s first two years

achieved shared savings

exceeded quality targets

reduced inpatient and ED utilization

among patients served during the program’s second year

Integrated Health Providers have

The Role of Care CoordinationSoftware in ACOs

Community-basedACO Framework

In order to collect, analyze, and use patient information for optimal impact, information from the following systems must be readily available within the accountable care organization:

ACO

Provider ElectronicHealth Record (EHR)

Behavioralhealth systems

Populationhealth analytics

Health InformationExchanges (HIE)

Care coordinationsystems

• Connects multiple providers and systems ofcare across a common platform

• Unites medical health behavioral health, andcommunity-based providers

Integrated CareCoordination Platform

MedicalProviders

Mental HealthProviders

Intellectual and DevelopmentalDisabilities Providers

Homeless ServiceProviders

Care Coordination& Reporting

Integrated CareCoordinationPlatform

Integrated CareCoordinationPlatform

Data can help the ACO determine:

Where to direct its outreach

efforts

Where to add resources

Where to invest in new programs,

departments, facilities, equipment,

or staff

Where to cut costs

Integrated Care Coordination Platform

Cloud-based care coordination

platforms exist on the market

today that are:

Configurable, whole-person care

coordinationMobile ready

Care team management

Secure, compliant,

SaaS

Quality measures and reporting

Prioritization and risk stratification

Effective data exchange

Patient and stakeholder engagement

ConclusionPost-acute Alignment

Hospital

Specialists

Disease Management Programs

PopulationHealth Analytics

Payer Partners

Primary CarePhysician

Patient Activation

With the rapid growth of state Medicaid, Medicare, and commercial ACOs, now is the time to establish best practices for addressing the full spectrum of patient needs within an accountable care setting

Conclusion

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