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The good news, bad news of recent ACO results

This week, the Centers for Medicare & Medicaid Services announced 2014 results for 333 Medicare Accountable Care Organizations (ACOs). It’s pretty exciting news; 56% of ACOs reduced costs and improved quality measures and reporting, which is up from 40% in previous years.

The downside of the report is that only 29% of ACOs participated in shared savings, which is simply not enough. The ACOs are saving money, but they’re not earning revenue at the same rate. It’s clear that we, as in industry, have to do more to facilitate success.

Think like a payer

To earn shared savings, ACOs need to think more like payers. Unlike traditional fee-for-service models, new value-based-care models require providers to balance risk scores and quality measures for better patient care. They have to manage patient coding to account for risk, which is what payers do all the time.

As an industry, we need to improve care coordination tools for multi-provider networks, especially when it comes to engaging patients. Here are a few scenarios where having the right tools can make a difference to an ACO:

Do we need to order that test?

Sharing real-time information and test results can help avoid unnecessary costs. Collaboration tools can, for example, alert primary care physicians when one of their patients shows up in the emergency room. If she’s had a recent lab test in one place, those results can be shared instead of duplicated.

Are we doing enough to motivate the patient with chronic disease?

Patient portals are a great start, and we’ve only scratched the surface by engaging patients in a proactive way. Maybe it’s helping a patient who is overwhelmed with medications learn how to manage them. Or building skills through cooking and exercise classes. It’s incredibly important to help patients find new and different ways to improve their quality of life. It opens the door to new opportunities for reimbursement too, such as through the CMS Chronic Care Management program.

Where are the unmanaged illnesses in our patient population?

Some patients avoid the doctor. If they have heart disease and are not actively participating in their care, it’s only going to get worse. Finding unmanaged disease – tomorrow’s high-cost patients – can be as simple as an empathetic phone call to ask a patient, “How are you?”

Taking steps like these will help improve ACO savings rates. Similar care collaboration efforts have enabled all of Allscripts-managed ACOs achieve savings in their second-year. They recognize it’s not just about quality reporting and not just about reducing cost with better patient outcomes, but achieving all three with coordinated care to earn shared savings. It’s the Triple Aim.

To find out more about how Allscripts can help with value-based-care efforts, contact us.

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