Improving Non-Acute Services
We have included both improved access to emergency department alternatives as well as a focus on the appropriate and efficient use of post acute services in our approach to non-acute services. We have approached improving access to urgent care services by both implementing standards for access to primary care (through PCMH transformation) as well as partnering with urgent care providers.
The use of post-acute care services is the main driver of hospital referral region cost variation for both Medicare and Medicaid [18]. If an ACO is taking on risk in either of these payer categories, it is imperative that the organization has a strategy for managing post-acute care. We have been developing the following capabilities:
- Determine most appropriate level of post-acute care upon discharge from an acute facility (eg, home health vs. skilled nursing facility)
- Predict, to some level of reasonable confidence, the length of post-acute services required per episode of care
- Create a high performance post-acute referral network that can meet quality, efficiency and cost standards set forth by the ACO
The challenge in meeting these goals include the lack of high quality data required to execute on the first 2 objectives. In addition, development of a post-acute referral network is dependent on regional market characteristics. For example, if the region’s supply of post-acute facilities is limited, enforcing the ACO standards for high-quality post-acute care may be challenging. Executing a post-acute strategy that helps an ACO meet its financial and quality objectives may be one of the more challenging endeavors the ACO will undertake.
Engaging Patients in Accountable Care
Accountable care contracts provide a new imperative for providers to offer tools that help patients engage in their care outside of the traditional clinical encounter. Promoting shared decision making, where patients share preferences and clinicians incorporate these beliefs into clinical decision-making, is one of our primary patient engagement strategies. Systematic reviews have demonstrated the effectiveness of shared decision making in improving patient awareness and reducing variation in health care utilization [19–21]. In addition to shared decision making, we have invested in new video education tools and have updated our electronic patient portal to allow patients to access their clinical record, review educational materials, and communicate with their care team at their convenience. Patient engagement strategies are also embedded into other initiatives, such as our high-risk care management program. Keeping patient engagement integrated into all of an accountable care organization’s programs, instead of treating it as a distinct program, is critical for success.
Implementing Clinical Information Technology Tools
A majority of current clinical information technology tools have been created for synchronous, in-person delivery of health care, reflecting the dominant mode of care delivery in the US. However, under accountable care payment models, ACOs have the opportunity (and imperative) to deliver care either asynchronously and/or remotely. As we assessed our needs, we recognized several gaps between existing and desired technologies. Though many population health information technology frameworks exist, we have found three broad categories required for successful population health management: advanced data warehousing and analytics, next generation care delivery and coordination tools, and innovative clinical performance management tools.