What makes accountable care better suited to succeed where previous attempts at managed care? Why is an increasing number of healthcare professionals believing that their efforts to implement and support accountable care organizations (ACOs) and other value-based models are going to pay off?
According to Joe Boyce, MD, CMIO of Mosaic Life Care (formerly Heartland Health) in St. Joseph, Mo., several keys differences have emerged in the past few years that has many in the healthcare industry well positioned to succeed. “I’ve seen more change in the last year and a half than I probably saw in the last 20 years before, and it’s a good change,” he told EHRIntelligence.com last month at HIMSS14.
For one, the health information technology is more capable of giving healthcare organizations and providers population- and patient-level views of data as well as enabling the types of communication necessary for coordinating care between providers and patients.
“We’ve got data. We didn’t have the tools before to try capitation fairly and to communicate between the primary care and the specialists and who’s doing what,” says Boyce.
Another advantage is an understanding of how demographics and geography impact how successfully a health system and its clinicians can manage a patient population.
“We probably have one of the better setups for being a successful ACO,” Boyce explains.” We’re a sole community provider in a town where we’re the dominant play — that helps a lot. If you go to Kansas City or someplace like that where a patient can go anywhere they want, it’s much more difficult, especially with readmission penalties and things like that.”
Boyce and Mosaic Life Care speak from the experience of running three ACOs — four, he says, if you count their own employees and caregivers. The Missourian health institution is part of the Medicare Shared Savings Program (MSSP) and has contracted with both Aetna and BlueCross BlueShield to establish a couple commercial ACOs.
“The commercial ACOs actually have a nice advantage in that patients can have skin in the game in terms of co-pays and incentives. Medicare patients can go anywhere they want and that’s really an uphill road,” adds Boyce.”
That’s not to say that its Medicare ACO has struggled, Boyce is quick to make clear. “The good news is both of them work,” he continues. “We were one of the 29 that recouped the investment in Medicare as well as the Blues and Aetna ACOs. These weren’t huge amounts because the investment was pretty significant — we’re talking hiring care managers and a lot of technology development — to be able to transition from fee-for-service to value-based care.”
How technology makes accountable care doable
What these different flavors of ACO reveal is the need for useable health IT to be in place. The first is user-friendly EHR system that gives the clinician the right view at the right time whether it’s simply a single patient or a more complex patient population.
“The docs for the most part work on the individual patient who is there in front of them that day for a hospitalization or visit and they have a view of what hasn’t happened on one page. That’s all they have to look at,” Boyce says of the most basic view.
Through its work with Cerner, Mosaic Life Care has then enabled clinicians to take things a step up to get a wider view of the patient as part of a population. “With one more click they can show themselves, for example, a list of all their diabetics and who has which. And because we have some incentive for them to see that now with the ACO, we’re seeing the advanced docs doing that on their own,” adds Boyce.
Obviously, some clinicians have not taken that additional step yet and static reports are made available to them. But the important point for Boyce is that members of the care team are getting it, especially when incentives are tied into it and integrated into the clinical workflow via dashboards.
The move to accountable care has the CMIO seeing things differently and far more positively. ” It’s not like the old HMO where people basically got less healthcare and that’s how we saved our money. Now it’s quality measures, patient stats, etc. or else you won’t make a dime, so you’ve got to keep them happy,” says Boyce.
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