6 Characteristics of a Successful ACO By Steven Lash San Diego

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6 Characteristics of a Successful Accountable
Care Organization By Steven
Lash San Diego
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• 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.

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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.

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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.

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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.

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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.

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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 ACOs ability to
  earn shared savings payments.

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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 value-based goals is
  paramount to achieving the performance that
  benefits all involved.

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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.

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Thanks