Getting noticed by ACOs
There's been a lot of talk about accountable care organizations in the media lately, and the importance of partnering with an ACO. According to the Centers for Medicare & Medicaid Services, an ACO is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program.”
Accountable care organizations are an outcome of the Affordable Care Act, signed into law by President Obama in 2010. Accountable care organizations were created to promote better care and better health for individuals and populations at a lower cost. They must identify providers that excel in areas not covered by ACOs themselves. In addition, providers must be accountable for their patients' health, along with ACOs. That means providers have the financial incentives to do only what is absolutely needed.
How do providers position themselves so that ACOs will notice them? My advice is to first become knowledgeable about ACO objectives. Each ACO is trying to determine the best approach to running the organization in an effective manner. This includes looking at health care options for older people that they may not have known about in the past. In fact, accountable care organizations are now required to have much greater understanding of all services used by Medicare recipients.
Skilled nursing facilities are a prime example. Accountable care organizations, which tend to be based around a hospital system, now need to understand what happens in an SNF, including the costs it generates. Learning about SNFs allows ACOs to determine if an SNF is the best, most cost-effective option for a particular individual.
The role of the primary care physician is also changing. While primary care physicians are still very important, we are seeing a shift to teams of care managers working together to determine the best treatments. Most importantly, consumers are becoming more and more involved. Care should be driven by those who benefit from it.
For example, according to Pursuing the Triple Aim by Maureen Bisognano and Charles Kenney, the Minnesota-based HealthPartners adapted the Care Process Model. This model shifted its focus to reliability, patient centeredness and standardization. Greatly respected by many governmental organizations for its initiatives, HealthPartners is leading the way to a new model of health care.
How do ACOs work for individuals? Once a patient meets ACO requirements for care, the patient is able to connect to the organization. To date, I do not believe there has been much focus on educating our Medicare population about what an ACO can do for them. We should see more work in this area in the future after each ACO figures out exactly what the best methods are for gaining the positive outcomes we all strive for daily.
How do ACOs choose providers—and how do you persuade them to choose yours? Prospective partners should have a strong history of positive outcomes, along with outcomes that conform to an ACO's objectives. For example, most ACOs are interested in therapy companies that help patients recover fully from a hip fracture—but not if it takes 35 days. All variables need to be considered.
While you may not see benefits immediately, being associated with an ACO can be an excellent arrangement for your company. A partnership will work best if demonstrate outcomes that parallel the outcomes of the ACO. Your company should also be strong financially, as some risk is involved when partnering with an ACO. Shared risk between you, other providers and the ACO will help make sure you are all using dollars wisely.
Another positive reflection of this association is the number of patients who will come to you, should they need your services. An association with an ACO is very much a driver for future growth plans and opportunities at my company, Centrex Rehab.
I believe the best way for a company to get noticed is to sell its strong outcomes for better care, better health and less cost to ACO's through marketing. You must be willing to accept that a new day is arriving in the health care field. Organizations looking for a partnership cannot focus only on making money. This is a profound change for the better.
While working with an ACO has its risks, it also brings rewards. If you are ready to work collaboratively to better the health of patients, clients, residents and populations, partnering with an ACO is the way to go — and in my opinion, well worth it.Kristy Brown is the CEO and President of Centrex Rehab. She is a speech language pathologist and has 20 years of management experience.