Just as value-based care can take many different forms, every path to prepare for this transition itself is unique. Some practices are moving into full-fledged ACOs quickly. Others are testing the waters with hybrid models and pilot programs.
Before taking a bold step toward accountable care, you should consider the following success factors:
Leadership and internal culture
To manage this transformation, your organization must be able to attain buy-in at all levels. This begins with a leadership team that is aligned with the vision and willing to invest in it. Leaders must spearhead change management efforts and effective internal communications. Driving quality and innovation will also require input from all staff, both clinical and non-clinical. This will be easier to accomplish if your culture already promotes collaboration and openness to new ideas.
Technology and infrastructure
If your practice uses basic electronic medical records (EMRs), there are additional investments ahead. Actionable patient data will be the driving force of improved quality of care. Rather than offering volumes of patient data to providers, information must be targeted and meaningful.
There is much focus on the need for HIE technology in an ACO or population-based care management initiative. However, first-generation HIE technology, which simply aggregates data, will not suffice. To support collaboration and decision-making for your panel of patients, providers will need advanced capabilities that enable the sharing of meaningful and complete data across the care continuum. This actionable data combined with analytics can also be used to create dynamic care plans that offer real-time insight for the care team and your patients.
Technology can empower your patients to make better healthcare decisions. Social media, mobile applications, and online tools are all effective outlets to engage patients. These resources can also help reduce network leakage and optimize utilization.
Level of clinical integration
Clinically integrated networks (CINs) are a strong foundation for ACOs. CINs can easily promote shared protocols, efficiency goals, education, and training. If your practice isn’t ready to move directly into a full ACO, this structure can be a good starting point.
Population health management expertise
ACOs must be able to stratify patients by risk. Based on this data, your practice can develop strategies to manage those with the highest risk / costly health conditions. Once patient data is matched with the latest clinical standards, new ways to improve outcomes may be found. This analysis of population health will also provide a good baseline for your goals around quality and measuring progress.
If your organization lacks expertise in this area, you should consider working with a health plan that has proven expertise. Care coordination payments from these health plans can help you plan for these infrastructure investments.
Market growth potential
Practices in a highly competitive market will likely be motivated to take on risk in hopes of greater rewards. Market growth will also be an important strategy to offset reduced utilization. Organizations that can readily attract and retain patients will have a distinct advantage.
Whether you’re creating a full ACO or a pilot program, these factors should be considered prior to launch. By preparing to face these challenges now, your practice can position itself for a sustainable future.
Bruce Henderson is head of Integrated Solutions, Aetna Accountable Care Solutions.