5 avenues to ACO prosperity

Image courtesy of Sameboat via Creative Commons licensing.

In an effort to become more transparent and accountable while offering the best care possible, healthcare providers are aligning to form accountable care organizations (ACOs), which aim to use reliable and progressively more sophisticated performance measurements to support improvement and provide confidence that savings are achieved through improvements in care.

Noel Khirsukhani, vice president of business development at PatientPoint, consults healthcare providers in forming ever-so-complex ACOs. He spoke to Healthcare Finance News (sister publication of PhysBizTech) and offered his tips on forming a successful ACO.

1. Formalize the organizational structure
Healthcare providers should establish processes for promoting and coordinating care and reporting on cost. “It will be important to determine a governance and management structure for decision making, and legalize how the team plans to work together, get paid and develop the operational plan relative to technology,” said Khirsukhani. This provides transparency as well as promotes the group’s overall goal to achieve better care.

2. Design an effective workforce
One of the essential parts of a successful ACO is the healthcare workforce, Khirsukhani explained. “The ability to design and allocate a healthcare workforce is critical to an ACO,” he said. “The ACO must manage physicians’ patient workload and encourage productivity in a team-based incentive structure.” Khirsukhani said it’s also important for the team to manage partnerships within the ACO.

3. Invest in technology
Health organizations are just now realizing the true potential of technology and how it can start to implement change in the way physicians and patients approach not only disease management but healthcare in general. “Healthcare providers are using patient education tools, care coordination technology and secure online/mobile messaging to better engage and monitor patients throughout their entire care process,” Khirsukhani said. In addition, he said healthcare providers can combine this new technology with traditional printed materials to create an integrated patient engagement solution.

4. Know your population, manage your risk
The culture of risk management is already instilled within hospitals. Khirsukhani said ACOs need to utilize what hospitals have already been doing for years. “Managing risk is a vital element to the financial sustainability of the ACO, and as organizations move toward value-based models, the patient outcome will have direct correlation to the economic health of the organization,” he said. So to that end, ACOs should align population-based health management processes with evidence-based guidelines. For example, for highest-risk patients, the care teams partner with patients and their caregivers on complex condition management to maintain or improve their current condition. Medium- to low-risk patients require appropriate health coaching and physician guidance to support self-management activities and maintain healthy lifestyles.

5. Engagement is king
Patient engagement is a no-brainer but can be more difficult than it seems. “Physicians must understand that it is important to engage patients pre-, post- and at the point-of-care to help streamline care management and improve health outcomes,” said Khirsukhani. “Patients who are involved in decision-making about their health are more likely to understand how to take care of themselves and thus prevent a hospitalization or readmission.”