Are Accountable Care Organizations going to become a driving force in the American healthcare scene? The jury is still out on that question but there are some signs that would lead one to believe that they just might. To begin with, we all realize that the fee for service model although favored by physicians, cannot continue. Our government leaders know that Medicare’s financial problems have to be solved and many in Congress have long looked to an ACO type system as the solution. The Supreme Court’s recent ruling in favor of the Affordable Care Act and the results of our last election give the Obama administration encouragement to forge ahead with their plan. One last indication that ACO’s are picking up steam is the continued increase in the number. On July 1, 2012 CMS announced 89 new organizations bringing the total to 154. As of today the number has risen to 250. Some estimates reach as high as 300. I think you will agree there is a lot of momentum moving in the same direction.
If you buy into the above school of thought then it would lead one to believe that you need to prepare yourself to become a viable partner to an ACO. There are things that need to be done to accomplish that and I will go into those, but let’s suppose that Accountable Care Organizations never take hold. All that preparation and work is for nothing. I beg to differ. I think it just gets you to do what will make you a better provider now and probably what you should have done all along.
So what are some ways you can begin to position yourself as one that can bring something of value to an ACO. The single most important thing to remember is this will be a DATA driven conversation. You must know and be able to articulate what the data says about your facility. What is your hospital readmission rate, your average length of stay, how much does it cost you to deliver your care, do you have high customer satisfaction and what do your MDS quality indicators say? If you wish to get more specific, talk to the ACO’s doing business in your area and ask them what they are looking for. Keep in mind that all communities are not the same when it comes to the acuity level of their residents. CMS is going to put out performance measures on you that will not take that into account. That is why you need to be able to clearly explain that. If there is an area where you fall short it gives you an opportunity to talk about your performance improvement plan and the progress you have made in that area. Knowing your metrics is going to be key.
One of the main goals of an ACO is to keep people out of the hospital. If you can demonstrate that you understand this and put programs in place that aid in that goal then you will go a long way in making yourself more inviting.
Care coordination is one of the main ways in which an ACO stays in touch with its beneficiaries and assists in the effort to keep them well. Making sure physician appointments are made and kept, medication regimens are adhered to and red flags that may signal a problem are recognized are things a skilled nursing provider can do that will show an ACO you get what they are trying to accomplish and are willing to be a participant in that. At the same time, it helps you in your quest to be the best provider in your area. Functional Pathways Transitional Care Coordinator program can help you in that endeavor.
Wellness is another piece of the puzzle that not only gives physicians in your market a place to refer their patients to that understands the unique needs of the 50 plus crowd but allows you to market your community in a very positive manner . You are showing that person that you want to help them stay well while introducing yourself to them in case they do need your services sometime in the future. Wellness also provides you the chance to integrate yourself into organizations like the Arthritis Foundation, The Office of Aging and others that provide help and information to those of advanced age.
So even if Accountable Care Organizations never really take hold you can see that preparing for them will make you a much better provider and far more attractive to potential customers and their families.