Authors: Robert Connely and Jon Zimmerman
Accountable care is becoming hugely important for the healthcare industry as regulators, payers, and providers seek ways to reduce waste, improve outcomes, and produce better experiences.
Accountable care, also known as value-based care, is the idea that providers should be rewarded for the quality and financial efficiency of their care, not simply for the volume of services they can deliver every day.
This approach has been proven to reduce costs in a meaningful way. For example, accountable care organizations (ACOs) in the Medicare Pathways to Success program generated $1.19 billion in net savings in 2019, says the Centers for Medicare and Medicaid Services (CMS). Most of the savings are the result of reductions in hospitalizations, emergency department visits, and post-acute care spending.
Overall, more than 45 million Americans now receive care from providers participating in commercial, Medicare, and Medicaid ACOs.
With the continued growth of value-based care, healthcare providers across the care continuum need to start preparing to adopt these innovative models – or at the very least, to work more effectively with partners who are increasingly accountable for their clinical and financial outcomes.
If they are to succeed, healthcare organizations will have to reinvent the way they interact with digital information, regardless of whether the care is delivered in-person or virtually through telehealth.
In our previous blog post, we discussed the challenges of data fragmentation and the urgent need for precision information delivery at the point of care. Creating true value from digital data requires intuitive access to curated, intelligent, relevant insights when and where they are needed.
Today we will explore why precision information delivery is so important for achieving the clinical, financial, and workflow goals of accountable care.
Reducing waste and achieving financial targets
ACOs are built around a novel framework for earning financial incentives. Participants who successfully improve quality and hold spending below expected levels for a defined set of attributed beneficiaries are eligible to keep a portion of those savings. For providers in downside or two-sided risk models, failing to meet the target could mean paying back a percentage of the overages, and nobody wants that.
Risk-based models create a strong motivation to avoid some of the most common forms of financial waste, including duplicated services, unnecessary ED visits, avoidable hospitalizations, and preventable long-term care admissions.
To do so, providers need complete and up-to-date information about what tests have already been ordered, what underlying conditions might lead to an ED visit if left untreated, and which medications could conflict and lead to an adverse event.
In the current health IT environment, providers often have to spend their precious time and brain power hunting through multiple portals and lengthy reports to identify and synthesize key information that could help them avoid a costly event for their patients. Missing information must be collected again and synthesized from patients or from partner providers, leading to delays in treatment, potential errors, and widespread frustration.
Precision information delivery tools can leapfrog these obstacles by identifying, extracting, analyzing, and presenting contextually relevant, actionable insights directly within the main workflow. As a result, providers can make more informed decisions about cost-saving steps such as avoiding repeated testing or enrolling patients in chronic disease management programs.
Improving outcomes for patients and populations
Accountable care models stress the inextricable connection between reducing costs and improving outcomes to avoid rationing of care or denial of services. Cuttings costs at the expense of care quality does not lead to shared savings, so providers must keep the patient’s holistic wellness needs front and center.
That’s where population health management techniques, such as routine preventive services and chronic care management initiatives, start to shine. Delivering less expensive preventive care before an issue escalates into an emergency can keep patients healthier for longer while preventing the need for costly services down the line.
To address wellness opportunities quickly and efficiently, clinicians need to know when a patient is due for a routine service or how they are trending with the clinical indicators of chronic disease.
Unfortunately, most electronic health record (EHR) systems were not originally designed to help providers take this proactive approach to managing populations. While EHRs provide the foundation for documenting and storing data, value-based care participants now need smart, contextualized tools to take them the next mile into population health management.
Leveraging precision data delivery technology to augment the EHR can serve up specific, contextually relevant, actionable, timely steps to take for each individual. By enhancing existing health IT infrastructure in this manner, providers will find it easier to close gaps in care and improve outcomes while keeping spending under control.
Fostering better experiences for both patients and providers
Better health and lower costs are only two of the three components of the Triple Aim of value-based care. The third target is improving experiences for patients and their healthcare providers.
Precise and intelligent information delivery can make this happen within the accountable care environment. With less effort spent searching for information, remedying past mistakes, repeating services, and coordinating care, providers can reduce cognitive burnout and focus their limited time on building real relationships with their patients.
More opportunities for robust, genuine conversations can help build and maintain trust between healthcare partners and allow providers to address additional areas of concern, such as the social determinants of health, that may contribute to poor outcomes.
Both patients and providers place a high value on these relationships and view positive, meaningful interactions as the hallmark of quality care, according to one recent focus group from the Council of Accountable Physician Practices (CAPP).
Patients also expect their care to be rooted in evidence-based protocols and coordinated across disparate systems – expectations that are difficult to meet without access to comprehensive and contextualized information presented in an easily-consumable format.
As the accountable care environment continues to grow, expand, and evolve, healthcare organizations will need to equip themselves with smart solutions for making precise and relevant data available within the workflow.
By gaining access to the right information at the right time in an intuitive manner, providers can reap the rewards of shared savings while producing better patient outcomes and better experiences for all. Everyone wins.