3 Critical Components to ACO Success

While researching my Top Tech Trend on accountable care organizations (ACO) highlighted in the March cover story, I had several excellent interviews on this ever-changing topic. Ultimately, there were many things I couldn’t fit into my ACO trend, including some of perspectives that were very interesting from Jim Adams, managing director, research and insights, and Anthony D’Eredita, EVP, Southwind, both at The Advisory Board.In our conversation, Adams mentioned that he had recently spoken to a hospital CEO about his organization’s ACO plans, and the CEO said that he was quite confident his organization could meet the requirements rather easily since his organization was at a HIMSS Analytics Stage 7 in EMR adoption. “Well that didn’t include a lot of other components and capabilities outside the hospital and even within the hospital,” said Adams.I think there are a lot of organizations out there that might be under false impressions that because they’ve reached the top rung of the EMR adoption ladder, that ACOs is just another rung over. But there are so many other facets like health information exchange and coordination with outpatient facilities that isn’t in really included in that Stage 7 level. That’s why John Hoyt, executive vice president, organizational services, HIMSS, said when I interviewed him last fall about recent Stage 7 winners, that additional stages involving HIE and accountable care readiness are likely to be created to meet those needs.D’Eredita noted that organizations need to attack three critical areas to achieve ACO success:

1. Create network interconnectivity for seamless data exchange across the outpatient and inpatient arenas
2. Provide processes for all clinical knowledge management and data aggregation to be able to put reports into the hands of caregivers for evidence-based practice of medicine, as well as to understand the  costs of care
3. Activate patients to take responsibility for their own care through patient engagement and care coordination tools

Adams and D’Eredita have seen several different iterations of how organizations are now creating accountable care organizations. D’Eredita says he’s been working with clients like:

• Primary care practices that are focusing on coordinating hospital discharges and reducing readmissions rates
• Specialists in medical groups who are co-managing service lines like cardiology, vascular surgery, orthopedics, and others, with their affiliated hospitals, “They are being incentivized to achieve certain outcomes that allow the facility to create value by improving quality and cost.”
• Once co-management structures are in place, some of these organizations are entering into bundled payment opportunities to take on more risk-based reimbursement payment structures
• Organizations  that are clinically integrating across mixed medical staff, and working to get FTC approval for and negotiating with payers for shared savings arrangements