The healthcare industry is buzzing about Accountable Care Organizations (ACOs) and the race among hospitals, health systems and medical groups to form them. ACOs are not new to the industry, but recently have become even more of a hot topic.
Recent statistics indicate the growing trend. According to data from the Medicare Shared Savings Program, the number of ACOs has skyrocketed in 2012—89 new ACOs were granted operation by the Medicare program since July 1, and the total number of ACOs has more than doubled since 2011. ACOs are growing faster than industry leaders predicted when program rules were originally drafted.
ACOs are defined by the American Hospital Association (AHA) as provider organizations that accept responsibility for managing the health of a defined population of patients and are accountable for quality of care, patient service and the cost of care.
When an ACO is formed, hospital administrators and physician groups enter into a shared savings contract and according to a recent article in Modern Healthcare, agree to manage medical care for a specific group of patients indentified by the doctors they visit. The expectation of the partnership is to cut healthcare costs, while efficiently identifying, monitoring and treating patients to prevent more costly care down the road.
Driving improved outcomes, decreasing costs and keeping track of patient populations are critical at a time when baby boomers are reaching retirement age, and when chronic illnesses may occur that would require hospitalization. It’s considered the new model for managed care, so the focus is to structure ACOs in a collaborative way. The goal is to reduce avoidable hospital readmissions and future risk of high-cost care—therefore saving money for patients, hospitals, medical groups and insurance providers.
Driven partly by physician-guided and collaborative frameworks like the Triple Aim Model, ACOs will need two important things to be sustainable—community connections and care coordination technology to drive improved patient outcomes.
Connections between hospitals and physician offices exist informally, but these relationships will need to be even more aligned. Exchanging information from electronic health records (EHRs) and practice management systems is one way to strengthen them. Increased use of technology through direct messaging and mobile applications, as well as care coordination with population health management (PHM) tools are essential for ACOs to become fully operational.
In a White Paper from the Integrated Healthcare Association (IHA), this topic is discussed. “The foundation of contemporary ACO initiatives is a mutual commitment to this data exchange…a matter of importance if the ACO is to intervene early in preventative and care coordination.”
Whether you are just starting to consider an ACO or are almost there, hospitals and physician groups need to capitalize on patient data connections that cross care settings—because quality measures and financial performance depend on them. Filling connectivity gaps with a data exchange, along with direct messaging tools, are important tools for hospitals to engage and grow their healthcare networks, especially when multiple systems are in place.
Today, there is an even greater expectation from patients to have information at their fingertips, so the use of dynamic mobile applications is expanding. Creating opportunities for patients to be active partners in their care will make for a healthier and happier patient population. The hope is that healthier lifestyles will require less healthcare overall—exactly what ACOs are all about.
Once your care networks are expanded, which use cases will be most important to your organization? How do you view these new ACOs in terms of setting priorities and facing challenges for those who want to form one?
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