Four steps to a winning accountable care strategy
It’s an historic moment for population health. As the baby boomers become Medicare beneficiaries and chronic disease skyrockets, the Centers for Medicare & Medicaid Services (CMS) has announced a monumental shift toward value-based care by 2018. Hospitals and health systems are being asked to manage patients’ comprehensive (and often complicated) care needs, as well as take on accountability for the associated cost.
Major health systems have been recognized for their commitment to value as part of the Healthcare Transformation Task Force. But I believe that community hospitals have a large role to play in this transition, for the same reason that regional hospitals and healthcare institutions have always been known for their quality and affordability.
Many community hospitals are successfully navigating the transition to accountable care, despite the perceived cost and complexity that have discouraged others. No organization can afford to invest in the system modifications that a transition to value-based care requires without a strong strategy. Managing the care of a population with coordination and purpose is no small task. It’s important to have a solid plan in place to meet quality thresholds, maximize revenue, and reduce costs in order to ultimately realize profit. With the right technology and visibility into operations, community health systems can improve the care experience.
Here are four scalable population health management strategies for community hospitals that can help them thrive as they transform their care.
1. Get to know your data
The right technology tools are critical weapons for helping providers under accountable care engage more meaningfully with their data. Cloud-based services that integrate clinical and financial data can put network-wide insight at one’s fingertips and make it actionable. This data must include claims, administrative, and clinical data in a single view. The right business intelligence tool can reveal where patients in an accountable care organization (ACO) receive care, how much it costs, and how high quality it is. Select a tool that not only lets you monitor performance across your network but also identifies areas for intervention – for individual patients and across the system – and handles reporting.
2. Manage referrals to stem out-migration
Referrals directed internally help maintain retention rates, support coordinated care, and streamline data collection for payers. Keep your providers aware of in-network options and make network-wide scheduling tools available to all staff to directly schedule appointments while the patient is still in the care setting. Educate patients about why local treatment options are effective, convenient, and cost effective – particularly compared to the larger (and more prestigious) academic medical centers in the area – and make access to that care easy via two-way communication tools like a patient portal. Managing your referrals will build patients’ familiarity with the high-quality care your institution offers in network and will build patient loyalty – a virtuous cycle. Of course, very few ACOs can provide absolutely all the care its patients need. This is especially true for community-based hospitals, which often need to refer out of network for acute and specialty care. Always refer to high-quality, competitively priced institutions. To do this, providers must have convenient access to data about location, quality, and cost of providers out of network. Consider partnering with care sites that can give favorable terms.
3. Grow your panel
Grow your panel by bringing in new patients, engaging inactive patients, and attributing all existing ones correctly. Providers must understand that they, like the health system, are financially accountable for their panel and are responsible for bringing inactive patients in for treatment. Your providers should know precisely who in their panel needs what care and what chronic diseases they live with. Engage patients who need office visits, screenings, or chronic disease management via targeted outreach. Ensure that existing patients are accurately attributed to your contract and, for the Medicare Shared Savings Program (MSSP), included in CMS data. This is especially important for patients who may have recently aged into Medicare.
4. Implement care plans to close gaps
Care management programs are expensive but essential to any population health strategy. Find out where gaps in care exist amongst your quality measures. Cloud-based services should be able to keep the latest quality management rules up to date, without a software update or additional cost, and align patient data to the specific quality measure an ACO is responsible for. Stratify your population and identify opportunities for intervention. You need an accurate representation of disease burden in a population to do this. Clinical documentation must be comprehensive and capture the full complexity of a patient. Smart coding features ensure that historical coding for each patient won’t fall off the diagnosis in the most recent encounter. Create care plans to address gaps, and take appropriate action. Patients with more than one chronic condition account for most costs and offer the best opportunity to reduce utilization. Properly segment your patients to focus resources effectively – not just by condition, but by whether their condition is under control.
Healthcare is hungry for value. Population health management holds many of the answers. No matter what a community health system’s motivation for participation, accountable care requires a fundamental shift in thinking.
