Issue link: https://www.e-digitaleditions.com/i/55648
Healthcare Trends Emergence of the ACO Model of Care H By Bernard Emkes, MD St. Vincent Health ealthcare today is a volume- driven, transaction-oriented business. We don't really get paid for taking care of patients; we get paid for doing stuff to them. The more we do, the more we get paid. The model of care known as the Accountable Care Organization (ACO) has been proposed for popu- lation based healthcare. The primary goal of creating ACO's is to enable and encourage healthcare provid- ers to take greater responsibility for reducing, or at least controlling, the growth of healthcare costs for a given population of members, while improving the quality of care those patients receive, from both a clinical and patient satisfaction perspective. An ACO is a group of providers willing and capable of accepting ac- countability for the total cost and qual- ity of care for a defined population of patients over a long period of time. In the ACO model of care, hospitals be- come the 'ancillary providers of care,' and success is dependent upon transi- tioning from volume to value. Multiple opportunities exist to im- prove the value and control the cost and care in the ACO. The primary medical provider's (PMP) practice can especially be instrumental in re- ducing the cost of care through sev- The primary goal of ACO's is to enable healthcare providers to reduce the growth of healthcare costs while improving the quality of care patients receive. eral strategies. Improving access to care in the PMP office promotes ear- ly intervention and diagnosis which decreases unnecessary visits to the ER and costly inpatient stays. The use of lower cost treatments, such as generic drugs when appropriate, can also significantly decrease the cost of care. Improved management of complex and chronically ill patients presents opportunities for cost re- duction. Nurse care mangers work with the PMP office to coordinate care of members with complex care by finding specialists to treat them in a timely matter, and by reducing repetitive testing and imaging. Care managers also work with members to help them understand their condi- tions, their medications and engage them in self care management. Tip of the month: Several mechanisms will be employed by the ACO to reduce healthcare ex- penditures and improve the quality of care. Medical management across the continuum of care, especially for mem- bers with chronic diseases is important for successful population management. Clinical information exchanges are needed for the efficient management of members to provide data to iden- tify members in need of services and those at high risk for costly care. The implementation of evidence-based best practices as an enhancement to the electronic medical record can improve quality of care scores and promote cost effective care. As public reporting on quality measures and members' expe- riences with their providers becomes more prevalent, it will be increasingly important for ACO's to improve qual- ity of care scores. The common element of all the strategies to sustain a successful ACO model of care is finding better ways to deliver care and coordinate servic- es to ensure all patients get the right care, at the right time, at the right place, from the right provider. The common challenge in any healthcare delivery model is engaging the mem- ber in their care. While ACO's will strive to implement initiatives to im- prove quality or reduce costs, the pa- tient's health and well being requires active patient participation for a positive outcome. With no strategies currently in place to ensure patient responsibility, the success of ACO's remains uncertain because members have no defined accountability for their own care. E–Services e-services is our web service that allows networks, providers, and members to access information on their medical authorizations and claims in a private and secure manner. Last year we averaged 1300 visitors per month! e-services allows provider offices to submit authorization requests, check authorization status, and check claim status. You can access e-services through our main website at www.cmcs-indy.com or e-services.cmcs-indy.com For questions about e services, click the on line help feature or contact us at: eservices@cmcs-indy.com CMCS connections 2 first qu arter 2012