Accountable care organizations (ACOs) are complicated, but the ins and outs of the care model have been discussed long enough. Healthcare organizations are now at a point where they have to focus on specific areas of ACOs to reduce cost and benefit patients, say two healthcare consultants.
"Organizations need to move toward thinking through the 'what' over the 'how,'" said Jim Fox, director and senior CFO consultant of Warbird Consulting Partners. "In many places around the country, healthcare providers are more worried about the structure and mechanics of ACOs over the function itself. There's a big difference between the two."
And clinical transformation is important, too, but the focus should be on the patient, not the doctor. “Once you've figured out how care is going to be delivered, the form it takes happens much more logically," said Fox's colleague, Doug Fenstermaker, executive vice president of healthcare at Warbird.
Fox and Fenstermaker shared five focus areas within ACOs that can help save money and benefit patients.
1. Implementation of practice
Healthcare organizations should be providing care that's actually needed versus care that isn't. Imaging, for example, is over-utilized in some organizations, Fox noted. "The protocol might be to do an MRI and prescribe a treatment based off the results. But maybe what's needed is physical therapy first, then a diagnoses," Fox said. "Imaging and additional physician visits are thus eliminated in this best practice." By consistently using best practices across a whole organization, medical errors are reduced, too.
2. Chronic care management
Healthcare organizations should reach out to the people in their communities and start to help them manage their health issues, such as diabetes. "If we work with them to manage and monitor their diabetes on a routine basis, we reduce cost to the hospital and the patient," Fox said. "It's imperative to eliminating acute care episodes through prevention."
3. Reduce administrative processes
Within ACOs, it's possible for healthcare organizations to work with primary payers on getting goals aligned, eliminating unnecessary care, managing chronic care and reducing use of resources to the benefit of both parties. A contract between the two then becomes more of an alignment on outcomes as opposed to simply who can get the best rate possible.
4. Improve access
By creating e-visits using telehealth, healthcare organizations can offer remote monitoring, meaning more patients can be seen more frequently. "And rather than having 'simple' stuff done by physicians, organizations can supplement with a nurse practitioner,” Fox noted. Some healthcare organizations are now offering incentives to physicians who work both in-person and through the Internet/telemedicine. Some are even making it a requirement for practice in their hospital.
5. All-care focus
The use of EHRs makes information available across the board thereby reducing unnecessary care and duplication. This enables the focus to be on the care and the experience of the patient, and it's effectively done at lower costs and more convenience to the patients. [See also: ACOs may stay afloat even if health reform law goes under]