November 10, 2015
4 Questions to Consider Before Joining an Accountable Care Organization (ACO)

Whether you’re a hospital, other type of healthcare or a physician, you might feel pressure to join an accountable care organization (ACO) — or even to lead the charge to form one yourself. An ACO is a group of doctors, hospitals and other health care providers, who come together voluntarily to provide high-quality, coordinated care to Medicare patients. The goal is to collaborate on communication channels, information exchange and clear referral pathways to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. And there are rewards in it for participating facilities and providers: When an ACO succeeds both in delivering high-quality care and making that care more cost-efficient, it will share in the savings it achieves for the Medicare program. The ACO model isn’t going to be right for everyone, but it is worth exploring. Before getting started, here are 4 key questions to ask yourself.

1. What does it actually cost to treat your patients?

This goes beyond merely looking at the chargemaster to determine what you’re billing for individual services, to understanding all the services involved in managing a particular condition, the total costs, and how much could be saved by ensuring that services — and, therefore, costs — aren’t duplicated. ACOs are part of the movement toward population-based healthcare, and that means looking for ways to standardize care and save money across entire patient populations. You’ll need access to payer data, the ability to analyze that data to identify opportunities for lower costs, and partners willing to collaborate to help deliver that high-quality care more efficiently.

2. Are you willing and able to invest in the technology and tools you need?

Your practice or organization needs to be able to communicate with other members of the ACO. This means ensuring EHR interoperability, exchange of images, reporting of diagnostic test and having direct lines of communication from the referral at one provider to the scheduler at another. Thus, you must assess your organization’s “alignment of people, processes and technologies across key functions. These functions include informatics, care management and patient engagement.” For example, patient-engagement tools could include developing an online portal to allow patients to access their records or educational resources (which you may have to create from scratch, or modify to work with those of other ACO members), to help empower them to participate in their own care.

3. How will you help physicians meet quality, efficiency and patient-satisfaction measures?

The culture of your organization should support physician alignment and leadership. Whether hospital- or practice-based, physician stakeholders should be involved as early as possible and encouraged to find ways to collaborate to involve the entire care team, to promote overall well-being, rather than provide intermittent sick-care. Physicians must be provided transparent information about quality and cost metrics they’re being asked to meet, and incentivized in line with those goals.

4. What strategies can be pursued for both continuous improvement and overall growth?

Although setting up an ACO is a challenge, it is an opportunity for reinvention, evolution and honing of how care is delivered. Standardization of service delivery might sound like an approach that removes opportunities for flexibility, but it’s quite the opposite — by standardizing, you minimize variables, which lets you pinpoint where care can be improved, adapted or supplemented. In addition to being prepared to innovate the coordinated care you set out to provide, your ACO should also be thinking about how to add new revenue streams. This can include targeting new services, growing the patient base (for example, by strategically expanding your network), and maximizing in-network care delivery.

By answering these questions (among many others) honestly, facilities and providers can set themselves up for innovation that fosters both affordability and clinical advancement.