A study of more than 1,600 U.S. hospitals revealed that value-based programs such as accountable care organizations (ACOs) appear to encourage the adoption and spread of care coordination activities by hospitals.
For the study, researchers categorized value-based program participation as participation in either an ACO or a bundled payment program. They then assessed adoption—whether a hospital was using any of a set of 12 care coordination activities as outlined in an American Hospital Association (AHA) survey—and spread (in each hospital adopting care coordination activities, how extensively those activities were implemented throughout the hospital).
Care coordination activities in the AHA survey included actions such as chronic care management processes or programs to manage high-cost patients; using predictive analytic tools to identify high-risk patients; medication reconciliation as part of an established plan of care; assignment of case managers to patients after discharge; and several more. Slightly more than 18 percent of the sample hospitals were participating in an ACO compared with 9 percent participating in a bundled payment program. Less than 5 percent of the sample hospitals were participating in both programs.
The researchers—who noted that programs such as ACOs and bundled payment models can improve the value of healthcare by enhancing care coordination activities by healthcare providers, including and especially hospitals—focused on 2013 value-based program data to understand how well prepared early adopters of these programs were to coordinate care. “Therefore, we consider our findings important in providing a baseline assessment of how hospitals may have responded to the incentives that these programs offer,” they stated.
A few key findings from the study, which was recently published in the American Journal of Managed Care, included:
- Overall, U.S. hospitals adopted a relatively high number of care coordination activities (nearly two-thirds, on average, of those possible) but were less interested in or effective at spreading these activities throughout the hospital.
- Opportunities to improve the use of care coordination activities are not evenly distributed, with hospitals reporting extensive use of some activities and minimal use of others.
- Hospital participation in value-based programs, especially accountable care organizations, may provide a catalyst to adopt and spread care coordination activities.
Among those hospitals adopting a specific care coordination activity, the most widely spread care coordination activity was the use of hospitalists for inpatients, followed closely by medication reconciliation. The least widely spread care coordination activity was the use of predictive analytic tools to identify individual patients at high risk of poor outcomes. This was followed closely by the use of post–hospital discharge continuity of care programs and nurse case managers.
The researchers concluded, “Despite evidence of their positive effects on quality, our study demonstrates that there is room to improve the extent to which hospitals use care coordination activities. Notably, these opportunities are not evenly distributed, with hospitals reporting extensive use of some activities and minimal use of others. Value-based programs such as ACOs and bundled payment programs appear to have the potential of improving the use of care coordination activities by hospitals.”
