Accountable care is a term used to describe a new model for payment and delivery of healthcare services. The goal is to lower costs while creating more positive outcomes, especially for the chronically ill. Instead of set fees for each service, the accountable care model ties the level of reimbursement to healthcare quality metrics and cost savings across an assigned population of patients. It also involves a higher degree of personalized patient care.
Achieving success with this new model of accountability requires the formation of regional organizations – Accountable Care Organizations (ACOs) – that work in a coordinated effort to serve patients in their region. This requires new partnerships, the free exchange of patient information, shared clinical data and mutual support among providers when critical decisions need to be made.
Key Elements of an ACO
There is no single approach to forming an ACO. Different regions and different populations have varying procedures and requirements. Along with assuming accountability for the overall health of their assigned patient population, and providing mutual professional support, key elements of an ACO include the following:
Team-based model – Coordinated care is delivered across the full spectrum of a patient's needs using the providers that are required by the patient. Data is freely shared among clinics, facilities and caregivers.
Advanced Health Information Technology – The latest mobile devices can continuously connect the patient, the doctor and the other members of an ACO, and share all necessary data. This helps in clinical decision-making and fosters more positive outcomes.
Personal Care Management – Personal care management aims to make treatment and therapy more flexible. Patients with chronic conditions or ongoing, specific needs require extra attention. Personalized care includes a greater focus on tailored therapy for the individual.
Shared Responsibility – A commitment to high quality and a willingness to share responsibility is a key element of any ACO. Collaboration is an asset. An ACO functions as a concerted group, not as a standalone entity dedicated to exploiting a single service.
Open Assessment and Reporting – Tracking costs, assessing the outcome of different types of care for the same illness or injury and measuring efficiency are all metrics that need to be monitored and reported. This information is used to fine-tune the operation of the ACO, allowing it to evolve along with the community it serves.
New Competencies and Redefining Value
Transitioning to a new model that changes traditional practice and incorporates high visibility and shared accountability will be a challenge for many established healthcare institutions. Organizations that insist on clinging to legacy methods will have the most difficult time. This translates to opportunities for skilled professionals who want to enter the field of healthcare management. People entering this challenging but rewarding field should be prepared to display competency in the following areas:
Collaboration and partnering – Sharing data, collaborating and forming partnerships are values that ACO members must embrace. Members must be open to redefining their traditional roles as new strengths and features of the organization reveal themselves through practice.
Technology enablement – New information and medical technology is breaking down factors like distance, and access to research and clinical data. Organizations must be willing to incorporate the latest information technology and be prepared to share data freely among networks. This supports collaboration and fosters data-driven decision making.
Information proficiency – All of the data coming into the organization through various means must be stored, managed and analyzed. Being able to handle this amount of data efficiently and securely while providing timely analysis is a necessity, and organizations will require professionals who are proficient in this skill.
Personalization of healthcare – Patients with the same illness may require different forms of therapy and care in order for treatment to be effective. Some patients are more adept at using information technology to research treatment options and want to take a greater role in choosing therapy or treatment, while other patients are uncomfortable doing so. ACOs seek to empower patients whenever possible, which can lower costs without compromising quality.
Talent creation and retention – Finding good employees and retaining them is a challenge for any business. ACO members must recognize valuable talent within their organization and offer training or other forms of recognition to retain individuals who display the skills necessary to improve their business. Since these skills can be unique from region to region, it is often easier and more efficient to promote from within when filling management roles.
Changes in Healthcare Delivery and Preparing for Success
The relationships formed by payers and providers in an accountable care system differ from those formed in traditional fee-for-service payment models. Potentially, there will be pressure to reduce the total number of care providers and keep only those with the highest quality care who can provide the best measurable patient outcomes. Healthcare providers are encouraged to form value-based partnerships that enable efficient and flexible delivery of patient services across the full spectrum of care. This provides hospitals, doctors, clinics and in-home caregivers with the financial incentive to collaborate in order to improve and increase available services, and reduce waste and redundancy. In some cases, payers and providers may jointly own clinics.
In addition to hiring talented professionals, healthcare providers should concentrate on the following:
- Assess their current standing in the provider market, determine where they want to be in the future and develop plans to reach that goal
- Seek effective collaboration. Payers and providers must forge new partnerships that lower costs, complement strengths, and provide patients with the most flexible and effective care.
- Expand communication efforts with patients. Used appropriately, social media can help educate and motivate patients through tools such as text messaging and online forums. Healthcare organizations should develop plans to adopt and adapt this technology to their benefit.
- Incorporate new technology and methods. Organizations that plan for and embrace a continual cycle of upgrades can develop strategies that help them remain at the forefront of new technology and advances in treatment.
- Collect and analyze data. New technologies will provide more data to an already data-rich environment; larger data centers will be needed to store and archive this information.
The Accountable Care Future
Strategic partnerships, collaboration, personalized healthcare and shared responsibility for patient outcomes can transform healthcare to a sustainable model that provides maximum benefit for patients, providers and payers. Many healthcare organizations in the United States are already moving forward and forming new partnerships that enhance value and lower costs. They are testing and implementing new technologies that allow for better ways to collect and analyze data, and increasing their efforts to communicate with patients and provide health and wellness features to communities.
This is an exciting time to be in the healthcare field, and many opportunities exist for professionals with healthcare management training and advanced degrees such as an MBA in Healthcare Management.