ACO’s & Healthcare Quality

An Accountable Care Organization (ACO) is a model of care that brings doctors, nurses, specialists and hospitals together to provide a higher quality of healthcare to patients. By using systems that connect between medical providers, it allows healthcare professionals to get a complete picture of the patient’s medical history. This helps them provide a higher level of care and eliminates duplicate processes, making healthcare more efficient as a whole.

How Accountable Care Models are Changing Healthcare

Traditionally, doctors and hospitals were paid using a fee-for-service system. This means that the more services a doctor provides you, the more money he or she makes. The more patients a doctor sees, the more money they make. Unfortunately, this results in rushed patient appointments, leaving the patient feeling like their health doesn’t really matter.

An accountable care model reverses the system. It rewards physicians and hospitals for providing patients with high-quality care and encouraging healthy habits. To work correctly, doctors, nurses, hospitals, employers and insurers cooperate and share information to help ensure the highest quality of care possible for each patient.

For example, you might see a heart healthy campaign start in the workplace by an employer who’s encouraging employees to get in a cardio workout at lunch. Then, doctors continue to their patient’s education by encouraging a heart healthy diet. Because of their efforts, patients remain healthy longer.

When patients stay healthy, doctors, hospitals and employers meet quality benchmarks and share in cost savings. Basically, the healthcare professionals earn more money when patients are satisfied with the level of care they receive, recover from illness quickly and remain healthy.

An important part of the accountable care model is that it requires physicians and hospitals to use evidence-based medicine to care for patients. This means that when determining the best treatment option for a patient, the doctor uses a combination of clinical expertise, evidence derived from medical research and the patient’s values to determine the best course of treatment for the patient in their care.

This helps eliminate unnecessary forms of treatment that may not work for the patient and cost the insurance companies thousands of dollars.

What is Value-Based Care?

Value-based healthcare is a model that pays doctors and hospitals based on the level of care they provide to their patients. This is determined by analyzing the patients’ health outcomes, instead of the number of services a doctor or hospital provides.

Instead of being paid on a per-service basis, providers are rewarded for helping their patients reduce the effects and risk of chronic disease, improving their overall health and living a healthier lifestyle that’s backed up by evidence.

There are several benefits to value-based healthcare that extend to patients and providers alike. For patients, high-quality care can help them avoid chronic disease and recover from injury or illness quicker.

This saves them both time and money in the long run because they’ll require fewer doctor visits and consume less prescription drugs.

Providers who use a value-based care process have more time to spend with their patients because they take on fewer appointments each day. The increased level of patient engagement results in greater patient satisfaction, which in turn, could lead to an increase in new patient referrals.

Also, providers get to spend more time focusing on new preventative care services instead of spending the majority of their time treating chronic disease.

What is Population Health Management?

Population health management is the collection and storage of patient data across numerous health information technology (HIT) services. Provider networks use population health management programs to store patient information in the cloud.

This way any healthcare professional in the network can populate a patient’s medical records which helps eliminate errors in treating patients, duplicate treatments and improper treatments.

The data collected on a patient can be used individually by a hospital or doctor’s office, but it’s stored in a way that creates gives patients cohesive, high-quality care. For example, when a patient sees their primary care provider the details of each visit, including the reason for the visit and the recommended treatment, is uploaded into the shared system.

Then, if the patient visits the hospital between doctor’s visits, the hospital staff can see exactly what conditions and treatments the patient has recently undergone.

This is especially helpful in documenting medications patients are taking. It eliminates the need for providers to rely solely on patients to inform them of all medications they’ve been taking. Instead, prescriptions are listed in the shared patient record so the provider can confirm them with the patient, decreasing the risk of the patient being given a medication that may react with others they are taking.

Successful population health management systems use real-time data. When a patient’s data is updated in real time, it makes it easier for providers to spot and address gaps in the care plan.

Performance Improvement in Healthcare

When providers follow an accountable healthcare model, things like performance metrics and outcomes are measured for their patients. Their pay is based on the quality of care they give and the results stemming from the care.

Outcome measures are used to determine how well the person responds to the treatment provided. The World Health Organization (WHO) defines outcome measures as “a change in the health of an individual, a group of people, or population that is attributable to an intervention or series of interventions.”

Some of the outcome measures that are tracked for each patient include patient experience, mortality and readmission.

Even though outcome measures are set in the US at a federal level, some health care organizations may set more aggressive or detailed ones that help ensure they meet or exceed federal requirements. Specific outcome measures providers are required to meet include:

  • Mortality rate equal to or less than 22 percent
  • Safety of care rating of 22 percent
  • Readmissions rating equal or less than 22 percent
  • Patient experience rating of at least 22 percent
  • Effectiveness of care ratings of at least 4 percent
  • Timeliness of care rating of at least 4 percent
  • Efficient use of medical imaging rating of at least 4 percent

Putting specific standards of care in place helps providers meet and exceed these target goals. In the healthcare field, the standards of care put in place by providers are called quality performance metrics.

When specific metrics are defined, it’s important to have quality control standards that are measurable because if a metric isn’t measurable, you don’t have a way to improve it. So meaningful qualify performance improvements have to be data-driven.

Providers need the right data, delivered in the right way, at the right time in order to improve the quality of the care they provide — that’s why specific metrics, such as mortality rates, are tracked by area, illness and provider.

In order for this to work, it’s important for providers to track every interaction they have with patients. This includes why they’re seeing the patient, what type of treatment was prescribed and any other concerns the doctor or patient has regarding their health.

It’s also important to track specific metrics over time such as blood pressure, weight and pulse rate. This way drastic changes can be caught quickly and the medical problem or chronic illness causing the problem can be properly treated.

What is Comprehensive Primary Care?

The Comprehensive Primary Care Initiative is a partnership between specific insurers and Medicare that’s designed to help certain primary care practices and providers obtain the resources they need to increase their quality of care. These resources and funds help providers make changes to their practice such as improving office technology and hiring additional staff members.

The initiative is a 4-year plan that requires collaboration between participating primary caregivers, commercial and state health insurance plans, and Medicare. The goal of the initiative is to help primary care providers develop and work to improve five core functions including:

  • Risk-Stratified Care Management
  • Access and Continuity of Care
  • Planned Care for Chronic Conditions and Preventative Care, and
  • Patient and Caregiver Engagement
  • Coordination of Care Across the Medical Neighborhood.

During the 4-year time frame, patient outcomes are measured to test whether or not the provision of these functions in the primary care office have an affect on the level of service each patient receives and how that affects their overall health. If the initiative can help doctors improve the level of care they provide, it should result in increased health levels for the general population, uniform care for Medicaid and Medicare recipients, and lower costs for both providers and patients.

If a person’s primary care physician decides to participate in this initiative, the patient will receive a notice in the mail from the doctor’s office. The notice informs the recipient that Medicare will be sharing specific personal information with the doctor so that he or she has the most up-to-date health records for them.

Basically, doctors receive access to a patient’s complete medical records, including treatment they’ve been receiving or have received from other doctors, clinics and hospitals. This keeps all providers on the same page and makes it easier for doctors to spot gaps in a patient’s treatment plan.

There are instructions in the notice that patients can follow if they don’t want their information shared. However, it’s important to note that when medical information is shared between medical providers, it results in a much higher level of care. In some cases, it helps ensure patients are getting the correct treatment for the symptoms they’re experiencing because the doctor has all of the information needed to make an informed decision.

The Overall Goal of ACO Healthcare

The overall goal of an accountable care organization is to provide the highest level of care possible to each and every patient they serve. To do this, they focus on more than just the symptoms, illness or injury they’re treating. They also focus on preventative care and a person’s overall health.

In order to provide proper treatments, healthcare professionals and clinics keep patient information in a shareable database. This way, when a patient visits the emergency room, an urgent care or any other provider other than their primary care provider, they have the patient’s complete health records in front of them.

Because they have an entire medical history, it’s easier to determine what type of treatment will be most effective, ensure new medications don’t react to current ones and spot any gaps in the type of care a patient is receiving.

It’s also important for doctors to focus on quality of care instead of quantity of care because, in the long run, it allows them more time for their patients. When preventative plans are in place for a patient to follow, it helps reduce the person’s risk of developing chronic conditions or getting sick on a regular basis.

Because of this, patients require appointments on a less frequent basis, allowing physicians to allot more time to each individual patient they treat each day.

Additionally, by focusing on healthy habits and preventative care, people remain healthier. When this happens doctors are rewarded. Employers can also reap some of the benefits of value-based healthcare by implementing health campaigns for their employees to participate in.

When employees actively participate in employer-sponsored programs, employers can qualify for cheaper healthcare plans, which benefits both the employer and its employees.

Workplace health campaigns vary between employers. However, some of the more common initiatives encourage employees to quit smoking or to lose weight.

Some employers may opt to pay for tools that help their employees quit smoking, others may encourage cardio workouts or build a workout facility in the office for employees to use. Some workplaces choose to focus on educating employees on healthy eating habits and encouraging them to follow through.

When it comes to an accountable care organization, you’ll notice there are a lot of different factors and people at play. It’s every element collaborating that makes the concept work.

That’s because people are encouraged and motivated to implement healthy habits everywhere they go. And the more educated they are on a topic, the more likely they are to take the necessary steps to remain healthy.