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Risky Business: ACO checklist for 2020 includes embracing new payment models and physician re-engagement  

The key for ACO success this new year and in the coming years, based on the experience of high-performing organizations, is to focus on the basics of patient and physician engagement.

The term accountable care organization (ACO) dates back to at least 2006. The Affordable Care Act then made ACOs a fast-growing trend thanks to the Centers for Medicare and Medicaid Services (CMS) launching its Shared Savings Program in 2012.

Since then, ACOs have been at the forefront of the value-based care model transition, taking incremental steps toward having healthcare providers bear a greater share of the cost of healthcare for their patients. That has forced health systems and physician practices affiliated with ACOs to redesign processes focusing on preventing expensive care services.

It appears to be working. Several recent studies show that ACOs are reducing healthcare spending and improving outcomes for patients. In light of such results and that organizations keep improving with additional years of experience, and new technology to support them, the ACO concept is not likely to be going away any time soon, no matter what happens in November.

Yet, in 2020 and beyond, challenges remain, especially for organizations that have not considered assuming any financial risk in value-based care programs. The key for ACO success this new year and in the coming years, based on the experience of high-performing organizations, is to focus on the basics of patient and physician engagement. At the same time, ACOs must embrace greater financial risk before it is thrust upon them by CMS and other payers. With that, the following is a checklist for ACO success in 2020.

Pursue Risk
In December 2018, CMS issued its “Pathways to Success” Final Rule which reforms elements of the Shared Savings Program. Changes included discontinuing the one-sided risk Track 1 program option and shared-risk Track 2 with a new BASIC path that helps Track 1 ACOs transition over five years to gradually accepting more risk. There is also an ENHANCED option (based on the higher-risk Track 3 program) for ACOs that are proficient with two-sided shared savings models. BASIC track ACOs can earn up to 40% shared savings for one-sided models and ENHANCED ACOs up to 75% shared savings but could also face up to 75% losses.

These changes, according to CMS, were motivated by the fact that more than 80% of ACOs in the MSSP were still participating in the upside-only Track 1 and that these organizations saved CMS approximately $28 per beneficiary less on average than their two-sided risk-bearing counterparts.

As the largest payer in the country, CMS is often a bellwether of commercial health insurers. ACOs can expect in the coming years that these payers will follow the agency’s example and require organizations participating in their value-based care programs to assume greater financial risk. That’s why in 2020, ACOs should begin pursuing contracts that include greater two-sided risk elements to gain experience while they still have time to learn, adjust workflows and improve performance.

ACOs that are seasoned risk-takers could begin considering forming their own Medicare Advantage plans in 2020 for the regions they serve. Medicare Advantage plan enrollment has doubled since 2009 with one-third of beneficiaries now holding such a plan. ACOs that have a solid track record of controlling costs, delivering high-quality care, and retaining patients in their networks could significantly reap greater rewards by launching their own MA plans.

Re-engage Physicians
When ACOs were introduced, a challenge faced by many leaders was educating and earning buy-in from participating physicians about the organization’s goals as well as adjusting workflows to improve performance on quality metrics. Fast-forward nearly a decade and physicians are now being pulled in so many different directions with competing value-based care programs that they may not be aware of the unique goals or quality requirements involved with participating in the ACO.

These “over-engaged” physicians, particularly if they practice in independent groups, may require outreach in 2020 to update them on ACO goals and requirements as well as support to help them achieve better performance. Monthly or more frequent communication, including personalized snapshots culled from a population health management platform, is essential. In these communications, sharing a consistent message about the ACO’s objectives and expectations will help cut through the noise and re-engage physicians in the ACO’s mission.

Pace Yourself
At the same time, while educating physicians and supporting their success, it also is important in 2020 to concentrate on achieving sustained improved performance on quality and cost measures. Less experienced ACOs often jump from trying to improve one metric after another without giving their providers adequate time to implement workflow changes, assess the results and change tactics, if needed. Prioritizing care quality and cost metrics and gradually introducing improvement initiatives throughout the year based on results is often the best course.

Deepen the Social Connections
ACOs that focused last year on helping high-risk patients overcome social determinants of health (SDoH) obstacles need to continue these initiatives in a coordinated fashion heading into 2020. SDoH will only continue to become more intertwined with achieving optimal outcomes in the coming years, which means ACOs will need to forge deeper relationships with community-based organizations that support higher-risk patients, as well as with patients themselves. Care managers should be able to use secure email, text message, or voice messaging to efficiently reach patients and begin a conversation that leads to treatment plan adherence and engagement in their health.

Make Data Actionable
By now, all ACOs have some type of data analytics platform to analyze quality and cost trends, but the data may not be actionable. In 2020, ACOs will want to examine their IT systems to ensure that they are providing the insight needed to support participating providers in achieving improved performance. This visibility into quality and cost metrics is mandatory when embracing greater risk. The ACO must be able to identify negative trends and correct them early to protect their shared savings or value-based care payment and improve patient outcomes.

Although riskier times for ACOs are likely ahead, they have the advantage of collective industry experience and population health management tools that were not available in years past. Combined, these assets can help ACOs or any integrated healthcare organization, regardless of their value-based care experience, move forward with greater clarity on their competencies, opportunities for improvement and the health of their patients.

Photo: Roman Valiev, Getty Images

 

 

 

 

 


Josh Patten

Josh Patten is Vice President, Advisory Services at Lightbeam Health Solutions.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

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