AJMC's ACO and Emerging Healthcare Delivery Coalition: First Live Meeting Coverage | Page 2
Published Online: June 23, 2014
“We don’t want to be looked at as an outside vendor, we want to be looked at as another department in the hospital, so we work really hard to integrate, we have our staff go through all of the orientation as though they were an employee at the hospital, so we are really proud about that,” said Dr Cohen.
With nearly 1 in 3 patients nonadherent to the medications that manage their disease, health systems require treatment programs supported by a collaborative team to ensure patient wellness and healthy outcomes.
ACOs: Key Functions & PCMH Support
Paige Cooke, National Committee for Quality Assurance, defined an ACO as a provider-based governing body responsible for the provision of resources to meet the triple aim. It is supported by stakeholders that include payers, purchasers, pharmacy, and ambulatory care sites. The foundation of building any strong ACO model, she said, is the patient-centered medical home (PCMH).
She provided 2 testimonials that described the ACO experience. The first group was Bon Secours Virginia Medical Group. Bon Secours achieved savings in the first year of participation in the CMS Medicare Shared Savings Program, with enterprise-wide electronic medical record use, early adoption of the medical home model, and other patient engagement initiatives.
She also shared the example of the Montefiore Medical Center in New York, a group which also integrated patient engagement as well as implementing “innovative nurse-driven interventions that supported patient outcomes and experience.”
Ms Cooke noted that the PCMH model is the fastest growing delivery system innovation in the United States. As of March 2014, there were 7118 PCMH sites throughout the country. The National Committee for Quality Assurance (NCQA) ranks several PCMH quality standards on a score-based scale. PCMHs can help:
• Enhance access and continuity
• Encourage team-based care
• Identify and manage patient populations
• Plan and manage care
• Track and coordinate care
• Highlight performance measurement and quality improvement.
In 2014, there were various quality-standard updates to team-based care, behavioral health, and measuring costs. Ms Cooke noted that ACOs can provide valuable resources to support the delivery of patient-centered primary care including access and coordination of patient management.
“One of the most important concepts that ACOs need to embrace is that the patient-centered medical home model is an evolutionary one, it’s one that is designed to align with the growth and evolution of what is happening in health reform,” said Ms Cooke. She praised NCQA’s PCMH Recognition Program, which provides accolades to those ACOs and PCMHs which demonstrate success with implementing evidence-based practices within their health systems.
Real-World Best Practices: Financial Structures, Quality Measurement, Medication Management
Kelly Conroy, Palm Beach Accountable Care Organization (PBA- CO), LLC, provided insight into experience with managing patients at the PBACO. CMS accepted the group on July 1, 2012. As with other accountable care models, PBACO focuses on a triple aim of care, which includes improving the patient experience, improving population health, and decreasing per capita healthcare costs. Additionally, as a member of CMS’s Medicare Shared Savings Program, they are able to be rewarded for achieving specific quality and cost-saving benchmarks.
Ms Conroy noted that initial implementation was difficult. They had to put pressure on the community stakeholders, like hospitals,to buy into the accountable care model. It was difficult to convince providers and doctors that transitioning from the fee-for-service model to and ACO was not only possible, but the financially responsible and logical choice. It was important to reach out to physicians and let them know that their contributions were making a difference once they agreed to join PBACO’s efforts.
“We created this outside component of competition with our community stakeholders pushing on the doctors, and eventually, the doctors started answering the phones, and then eventually, the doctors started to appoint a point of contact in their office to get it,” said Ms Conroy. “And then, after they made $22 million or saved $22 million, then they got really interested in doing things.”
They quickly discovered that patient satisfaction was key to improving outcomes. Even something as a simple as a follow-up call was found to improve the patient experience. As a “low-tech” ACO, PBACO still found ways to engage patients in their care plans. She provided the example of their In-Form‐A‐Doc document which allows the patient to document health concerns and questions in between visits. She noted that it is important to keep track of patients and to treat the same patients prospectively assigned in the beginning of year as at the end of a tracking period. Still, patient engagement and outcomes can be improved, even solutions are low-tech.
“Patient engagement: I see a lot of ACOs went really high-end; patient portals, all kinds of patient engagements. We went very, very low end,” said Ms Conroy. “We used the Medicare opt-out letter that you have to send to patients as a good way to start talking to the patients, and it turns out once the physician had that conversation with the patient, the patient wants to save Medicare, wants to work closer with the doctor, and it made them feel good.”
Achieving Quality in ACOs: Are They Ready to Maximize the Value of Pharmaceuticals in Patient Care?
Kimberly Westrich, MA, director for health services research, National Pharmaceutical Council (NPC), said ACOs intertwine quality and cost-effectiveness like yin-yang.
“We’re moving to an ACO world, a value-based world,” she said, and changing to a different reimbursement model provides the opportunity to develop a strategic framework “where lowering costs and raising quality can really be merged.”
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