Asif: Accountable Care Organizations (ACO) are healthcare organizations characterized by a payment and care delivery model that ties provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.
An ACO refers to a group of providers and suppliers of services (for example, hospitals, nurses, physicians, and others involved in patient care) that work together to coordinate care for the Medicare beneficiaries they serve. To be eligible, the ACO must serve at least 5,000 Medicare patients and agree to participate in the program for three years. The goal of an ACO is to deliver seamless, high quality, patient-centered care for Medicare beneficiaries instead of the fragmented care that has so often been part of fee-for-service healthcare.
Asif: This is high time to start thinking about forming ACOs. The ‘Fee for Service’ reimbursement method is rapidly diminishing and being replaced by the radical ‘Shared Savings’ method. It is evident that the infrastructural developments and core capability building that are prerequisites for the formation of ACOs and population health betterment are still being developed by providers.
With an excess of 600 private and public ACOs across the country, and the 123 recently added ACOs (to the Medicare Shared Savings Program), it is safe to say that ACOs are growing. The future of ACOs may still be speculative, but it is certain that ACOs are work in progress.
CureMD: For a new group, why should they consider forming an ACO?
Asif: Between constant changes in the regulations, compliance requirements, increasing overheads and shrinking reimbursements, there is little for small practice owners and primary care providers to choose from. In many ways, running a practice is quite different from a conventional business. Healthcare providers have a much bigger responsibility – saving and improving patient lives. Using Medicare's conventional fee-for-service payment method, practices are paid per test and procedure. The process accumulates costs, sometimes exceeding what is seen as the ‘just’ reward for providers. ACOs don't cut off fee-for-service, but instead create incentives via bonuses for providers who work efficiently and consequently reduce costs. More importantly, by meeting specific quality benchmarks emphasizing on prevention and by vigilantly managing patients with chronic diseases, providers can also fulfill their most important duty.
CureMD: How are patients benefitting from the ACO model?
Asif: A coordinated care delivery team managing a select group of patients within their geographical reach can ensure deeper focus on their patients. Providers in the care team can interact regarding patient conditions and coordinate their healthcare efforts collectively.
CureMD: Are ACOs helping patients approach specialists?
Asif: Yes. Utilizing evidence based care plans along with suggested interventions; coordinators can manage the transition of care better by bridging the gap between PCPs and specialists.
CureMD: As a software vendor, how is your organization helping ACOs?
Asif: We realize the importance of population health management and accept our role in the development of integrated community networks to support ACOs. With robust analytics tied with usability-driven Electronic Health Record systems, we are providing a Cloud solution that performs the following functions required to run a successful ACO:
- Maintain a patient centered focus
- Develop processes to promote Evidence Based Medicine
- Promote Patient Engagement
- Coordinate Care
- Report on Quality and Cost internally and publicly
CureMD: What is the biggest threat to ACOs in terms of the sustainability of the model?
Asif: I believe that despite the excitement this model provides, the threat of high deductible plans is still prevalent. Furthermore, in healthcare decision-making, cost-saving efforts automatically create a tension between cost containment and the medical liability. Decisions involving financial success over member health could result in an array of lawsuits.
CureMD: With the ability of disparate systems to meaningfully talk to each other still in infancy, do you think the ACO model could survive?
Asif: Interoperability still being a challenge in health IT, I foresee alternate models emerging to overcome this challenge. EHR vendors can offer All-In-One Population Health Management solutions to Accountable Care Organization. Switching disparate systems to a single platform can eliminate cost of accurate data sharing and mapping. This is just shifting of cost and effort from one direction to another but it can guarantee the achievement of ACO goals in a timely manner.
CureMD: Do you believe ACOs are paving the way for population health management?
Asif: Yes. The ACO model itself has emerged from Population Health Management. For an ACO to successfully achieve its goals, it must follow population health management principles.
CureMD: Would physician-led ACOs be more successful than hospital-led ones?
Asif: Although Physician led ACOs are generally smaller than those run by hospitals, I foresee a better success rate for Physician-led ACOs over hospital ones due to following reasons:
- Savings differ for both systems. While the physician systems will work on keeping patients out of the hospital by providing better care upfront, hospital-led systems emphasize on better management of patients only once they are admitted.
- Freedom on working towards success in shared savings plans is higher for physician groups as several physician groups have witnessed success with the PCMH model; which has prepared them for a successful transition to becoming an ACO.
- The elimination of risk for physicians participating in an ACO if they fail to achieve savings is possible via techniques provided by Medicare. This lack of risk tempts the risk-averse physicians to enter the market.
CureMD: With the SGR cuts delayed by the government recently, do you think the fee-for-service model would be easy to discard for physicians?
Asif: I don’t see any impact of this delay. Shifting to new payment model by the physician would mainly depend on the success of Accountable Care Organizations and all such initiatives. As per Medicare Sustainable Growth Rate (SGR), the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP, this rate cut will start affecting physicians by 2019.
CureMD: What is the most important attribute of ACO software?
Asif: Predictive Analytics and Care Coordination are two most important aspects of any population health management system. If you as an ACO can identify potential risks within your specified patient population well before time and coordinate care efficiently by using most automated processes, achieving the goal of cost saving and better healthcare is inevitable.
CureMD Integrated Community Exchange (ICE) provides a software platform which is not only seamlessly integrated with CureMD EMR for real-time data feeds but also provides predictive analytics, health risk stratification and efficient care coordination as an All-In-One solution.
Asif Rashid is the Executive Vice President at CureMD Healthcare and the brains behind their solution for ACOs and CureICE.