What Is an Accountable Care Organization in Healthcare?
Accountable Care Organizations are groups of physicians, hospitals, and other healthcare providers who partner to provide coordinated high-quality care to Medicare beneficiaries and ensure that people receive the appropriate care at the right time while preventing medical errors. Their goal is to improve the quality of care while lowering costs. ACOs provide incentives and tools to deliver care that promotes improved health for patients.
In 2020, Centers for Medicare & Medicaid Services (CMS) reported that ACOs in the Medicare Shared Savings Program (MSSP) earned shared savings of almost $2.3 billion while saving Medicare $1.9 billion. ACOs have accomplished net program savings for four consecutive years through prevention and avoidance of unnecessary hospitalizations, tests and procedures, emergency room visits, and post-acute care.
The value-based care model creates savings and incentives with bonuses when providers can minimize costs and meet specific benchmarks focused on prevention and managing chronic disease. As healthcare transforms towards value-based care, independent providers look to an Accountable Care Organization partner to adapt payment reform while also having their autonomy. Choosing the right ACO partner is the path to becoming part of a network of colleagues with the scale necessary to efficiently manage a population at risk and to share the expenses.
Accountable Care Organizations help develop strategic partnerships with other healthcare providers which includes hospitals, practices, and other healthcare systems that share in savings by collaborating to meet quality of care benchmarks and reduce costs. An ACO also creates opportunities to improve patient experience by sharing and refining existing tools and resources. Combining practical care strategies and easy to use innovative solutions greatly improves clinical and financial outcomes. Everyone can learn how they are performing and find areas in which to improve.
Having shared access to technology through an ACO is another great benefit. An ACO provides expertise in advanced predictive data analytics and reporting, innovative health technology (i.e.: telemedicine and remote patient monitoring), preventive and chronic care management, and population health management.
Without technology, care coordination and management are significant challenges, although some can be met with management partners. Practices with different electronic health record systems can still easily understand and compare patient outcomes data.
Quality Measurement and Improvement
When choosing the right ACO partner, the provider should make sure the ACO has a solid quality strategy that encompasses the organization. This might involve having health professionals that facilitate interventions such as remote patient monitoring. Another is to provide support to ensure that practices meet necessary quality reporting requirements. Reliable and accurate quality reporting is also key. When an ACO has knowledgeable resources committed to coordinating different quality metrics, it can make sure that communication with CMS is consistent, timely and accurate.
ACO Leadership Structure
Many Accountable Care Organizations are physician-led. They allow providers to be empowered to administer the care that their patients need. Overall, savings generated by physician-led ACOs are much greater than hospital-based ACOs. Investments made by physician-led ACOs are more effective since there are less barriers. They can react quickly to policy changes and shift their strategy and approach which can increase their chances at long-term success.
Physician-led ACOs have shown that they are more likely to earn shared savings when they are able to focus on eliminating costly hospital admissions without suffering a loss in inpatient revenue. Hospital-led ACOs may struggle by decreasing inpatient admissions in their capital-intensive inpatient facilities.
At the end of the day, care coordination benefits patients especially with a cost-effective, value-based outcome model like the ACO. The key is in the support. Choosing the right ACO partner is critical to a positive alternative payment model experience. ACOs with a strong framework with high-level administration, data analytics, and population health management can promote best practices while reducing the burden on physicians. Participation is then much easier and more profitable to all partners.
Netrin Health is an Accountable Care Organization that brings together a network of independent primary care providers with a core focus on value-based care. Providers aim to increase the value of health care for all clinical stakeholders and patient communities all while reducing costs and increasing revenue. With advanced data analytics, Netrin is able to combine clinical claims and quality data to identify opportunities for improvement. Netrin is not investor-funded or affiliated with any hospital system. Primary care providers remain independent in running their practices while thriving in emerging value-based health. Netrin works in collaboration with providers to improve patient outcomes and reduce unnecessary costs.
Doing the due diligence in choosing the right ACO partner can be challenging. Contact Netrin Health to learn how we can support you in the MSSP.
Centers for Medicare & Medicaid Services, Aug 25, 2021. Affordable Care Act’s Shared Savings Program Continues to Improve Quality of Care While Saving Medicare Money During the COVID-19 Pandemic.
LaFayette A. 2021. Home. Naacos.com. Home (naacos.com)
American Medical Association, Sep 12, 2019. A majority of physicians now take part in an ACO.