Health Information Technology (HIT) and partnerships with long-term and post-acute care (LTPAC) providers could enhance the ability of Accountable Care Organizations (ACO) to manage patient care and gauge the success of their initiatives, according to a collection of 4 case studies released in January 2012 by the Commonwealth Fund.
An ACO is a group of health care providers that agrees to be accountable for the quality, cost and overall care of a group of patients.
Importance of Relationships
The 9 authors of 4 Health Care Organizations’ Efforts to Improve Patient Care and Reduce Costs maintain that ACOs must build trusting relationships among physicians, payers and other collaborative partners.
The report suggests that the involvement of home health providers, nursing homes and assisted living facilities could enhance the ability of ACOs to manage patients’ health and care.
Yet, it also notes that most ACOs have only limited experience integrating their care with the care provided by LTPAC settings.
“This may prove to be a challenge as they attempt to coordinate care and hold down costs,” predicts the report.
The 4 ACOs included in the report also face a substantial challenge in navigating the legal and contractual arrangements associated with new payment models, which include provider-payer contracts that support prospective budget planning and internal distribution of shared savings.
In particular, say the authors, the organizations need to develop data-sharing agreements, establish patient attribution methods, understand the patient population and overcome regulatory hurdles.
The report notes that exchanging performance and financial data between providers and payers has been a challenge for the ACOs because of time delays and technical difficulties. However, the authors do note that the ACOs they studied are making some progress in this regard.
“Each payer-provider group has exchanged historical data and identified baseline performance status and benchmarks that will enable them to gauge the success of their ACO initiatives,” says the report.
ACO Case Study Participants
The ACOs featured in the Commonwealth Fund report include the California-based HealthCare Partners and Monarch HealthCare, the Kentucky-based Norton Healthcare, and the Arizona-based Tucson Medical Center.
As a group, the ACOs are owned by either hospitals or doctors, implement the ACO model in partnership with a private payer, and serve between 7,000 and 50,000 patients.
All of the ACOs featured in the case study collection participated in an ACO Pilot Program launched in 2009 by the Engelberg Center for Health Care Reform at the Brookings Institution and the Dartmouth Institute for Health Policy and Clinical Practice. CAST Chair Mark McClellan is director of the Engelberg Center.