Is an ACO Right for Your Company?
By John Foley, President, Wisconsin Collaborative Insurance Company
The Accountable Care model is used by both public and private payers to better align Providers, payments for services, and populations. At least 10 percent of the U.S. population is now covered under an ACO. When an ACO succeeds in delivering both high-quality care and using health care resources more wisely, it shares in the savings it achieves.
Healthcare gets accountable
ACOs must meet specific quality benchmarks, focusing on prevention and careful management, especially of high-risk and chronic disease patients. ACO providers can earn additional reimbursement by keeping patients healthier and out of the hospital. This contrasts with traditional fee-for-service health care where doctors and hospitals are paid for each test and procedure — with payments based primarily on quantity of care, rather than quality of care.
ACOs must meet defined quality measures. In most cases patients end up receiving a higher level of coordinated medical care, thus increasing patient satisfaction.
How can an ACO benefit employers?
By focusing on keeping their employees well and managing their medical conditions more effectively, health care costs may decrease over time. The benefits of adopting a long-term, proactive ACO solution include:
• reducing absenteeism
• improving employee retention and presenteeism
• decreasing employees’ overall health risks, costs of treatment, unnecessary hospitalizations
How does an ACO achieve these goals? Advocate Aurora’s Accountable Care Organization has successfully developed an integrated, coordinated multidisciplinary team approach. For example, some employers have an Advocate Aurora nurse assigned on-site to help employees:
• navigate the health care system
• monitor chronic conditions such as diabetes or high blood pressure
• get connected to a primary care provider for ongoing care
• learn more about their individual health risks and medical condition
Engaged, educated patients = improved health care outcomes
Many factors affect health care outcomes, including the patient’s own health habits and lifestyle behaviors. This is especially true for patients facing chronic disease. In addition to multidisciplinary care, a high-functioning ACO will employ evidence-based medicine and new technologies to help engage patients so they can better manage their own health. Most ACO patients appreciate being educated about their condition. They are more likely to comply with their care plan when actively partnering with their health care team.
Focusing on cost drivers
Individual health counseling for high-risk individuals can greatly reduce health costs and manage the course of impending disease or future hospitalization. Additionally, an ACO offers better management for those already diagnosed with a chronic condition (heart failure, diabetes, COPD, etc.). At Advocate Aurora, nurse navigators and care coordinators provide personalized, integrated care for the “sickest of the sick” who drive a high percentage of health care costs.
ACOs aim to improve access to primary and low-acuity care, ensuring patients get the right care at the right time at the right cost. This reduces costly emergency department visits.
EMR: the ACO connection
The electronic medical record (EMR) is key tool to an ACO’s success. When health care providers have fingertip access to complete and accurate information, patients receive higher quality medical care. At Advocate Aurora, the EMR allows all of our health care providers, clinics and hospitals to share vital patient information, as well as tracking progress over time.
Research shows that EMRs can enhance patient outcomes by:
• providing accurate, up-to-date, and complete information about patients, at every point of care
• helping providers more effectively diagnose patients, reduce medical errors and provide safer care
• enabling quick access to patient records for more coordinated, efficient care
• securely sharing electronic information with patients and other clinicians
• improving patient and provider communication
• ensuring safer prescribing (helping to avoid adverse medication interactions)
• streamlining the patient’s check-in experience
• avoiding duplication of tests
In short, responsible employers have a vested interest in keeping their workforce as healthy as possible. Improving the overall health of their employee population should be a key business-performance issue. There’s no magic wand to wave that will immediately improve employee health and contain health care costs. However, our experience shows that partnering with a high-performing ACO can help employers make notable strides in accomplishing this elusive goal.
John Foley is President of Wisconsin Collaborative Insurance Company.