6 Characteristics of a Successful Accountable Care Organization By Steven Lash A review of the literature shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies, organizational and environmental factors, and incentive and payer alignment.
Leadership and culture Leadership and culture is one of the most mentioned characteristics for success with improving care quality and reducing healthcare costs. If ACOs did not utilize physician champions, then having top-level leadership involved in achieving ACO goals was key to reducing costs and improving quality. ACOs leaders that engaged with providers earned greater system-wide buy-in.
Prior experience When the ACO has experience with value-based reimbursement and risk-based arrangements is a key trait. A track of dealing with these arrangements historically demonstrates a replicable model for the future as these types of arrangements become the norm. Previous value-based reimbursement and risk-based contract experience resulted in higher care quality and shared savings. ACOs that had risk-bearing experience, will score higher on quality metrics.
Health IT While Electronic Health Records (EHR) are a vital component of value-based care it is the utilization of the technology to coordinate care, identify high-risk patients, track patient care outside of the ACO, and create performance data feedback will yield reduced costs, improve quality of care and the patient experience.
There is no question that providing feedback to providers on disease prevention and cost savings and better patient outcomes will lead to a better result for the shared savings accounts and quality. The old axiom that better quality of care is the lowest cost of care still holds true.
Care management strategies Care management strategies such as performing Annual Wellness Visits, Chronic Care Management program and other strategies such as deploying care coordinators, plays a demonstrable role in quality improvement and cost reductions. These care coordinators and programs can help to reduce inappropriate emergency department as well as prevent the onset of new medical conditions.
Organizational and environment factors Organizational factors (e.g., ACO provider and beneficiary makeup) and environmental elements (e.g., regional and market differences) impacted ACO performance in terms of quality and cost reduction. For organizational factors, having more Medicare ACO beneficiaries per primary care provider can be linked to better disease prevention and health screening scores. Looking at environmental factors, being geographically located in a rural area as well as overall ACO market penetration bode well for ACO success. Rural locations is associated with higher quality scores, while greater market penetration was linked to an ACO’s ability to earn shared savings payments.
Incentive and payer alignment It should come as no surprise that aligning financial incentives between the ACO and its providers resulted in shared savings and quality improvement. On the most basic level this makes sense no matter what industry the organization is in. While many ACOs have embraced this modis operandi, there are many that have either not embraced this philosophy or cannot operationalize this most basic fundamental. Tying provider compensation (including shared savings distributions) to ACO or valuebased goals is paramount to achieving the performance that benefits all involved.
Successful ACOs align with the PCMH initiative
The 6 traits of successful ACOs align with the patient-centered medical home (PCMH), suggesting an association between advanced primary care and ACO success. Advanced primary care relies on the following factors: • • • • • •
Importance of a clinical champion Culture of accountability among staff An advanced EHR to identify and manage care for high-risk patients Performance feedback available for provider Focus on decreasing ED visits and hospitalizations Enhanced access to PCPs
It should be evident that these principles if embraced by the ACO can lead to the success as it has for the PCMH model and can foreshadow their results.