Since a landmark study in 2018, six factors have been identified that will lead to accountable care organizations’ success. This report, from the Patient-Centered Primary Care Collaborative and Robert Graham Center, consisted of a literature review and determined that accountable care organizations (ACOs) roadmap for success fell into the categories of:
- Leadership and Culture
- Prior Experience
- Health IT
- Care Management Strategies
- Organizational and Environmental Factors
- Incentive and Payer Alignment
This report found that the accountable care organizations’ success led to reduced costs, improved patient satisfaction, and advanced population health. Let’s look at each one in turn.
Leadership and Culture
One of the most important findings of the report was that accountable care organizations succeeded when they placed physicians in leadership roles, in positions they referred to as “clinical champions.” The report states: “At an organizational level, a cross-sectional study of Medicare ACOs found a positive correlation between savings per beneficiary and both physician leadership within the ACO and the number of physicians acting on the governing board.”
This isn’t to say that these clinical champions were requirements for success, but that someone needed to fill that role. If it was not a physician, then it would need to be leadership that engaged in physician buy-in. This buy-in led to physician improvement, which led to both better outcomes for the patients and lower costs for the ACOs.
This should seem like an obvious point, but it bears repeating: the longer that an accountable care organization is in operation or the more staff it has who have previously been involved with an ACO is an extremely important factor in the sustainability and cost-effectiveness of the organization.
This is found in value-based reimbursement and risk-based contract experience. “These findings suggest that experience makes a difference and that, over time, ACOs are learning and improving to adjust their workflows and capabilities to provide cost-effective, high-quality managed care,” the report states.
One of the most important aspects of health IT is the availability and accessibility of electronic health records. And it should be no surprise that an accountable care organization’s success was tied to managing its health IT processes. This led to better overall results in the care of high-risk patients, as well as the ability to track patient care outside the ACO. Studies of ACOs with better EHR management were found to score higher on disease prevention metrics.
Care Management Strategies
The care management strategies that contribute to accountable care organizations’ success included such things as the proper use of care coordinators, preventative care, and high-risk patient management. In fact, the very presence and support of care coordinators were shown to have a significant effect on the success of the ACO. These care coordinators fill many different job roles, from home health nurses to clinicians to healthcare workers who help patients access available services. These were particularly helpful in cases where housing and welfare were at issue.
Organizational and Environmental Factors
This category often refers to the area in which the accountable care organization is found (rural versus city, accountable care organization market penetration, etc.) and relates to issues such as disease prevention and annual health screening scores. But it was more than that, because studies also found that accountable care organizations’ success increased when they collaborated with primary care providers because they showed better health outcomes and lower costs.
Incentive and Payer Alignment
It was found that an accountable care organization’s success was tied to incentive structure between the ACO and the providers and consultants. Other methods, such as shared savings payments, were also important to the overall accountable care organizations’ success.
It is clear from these findings that accountable care organizations’ success can be found when clearly laid out objectives and goals are set, with a leadership-down structure that emphasizes health IT technology and proper incentivization. The support of care workers, including “clinical champions” and care coordinators, is also very important.
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