An Accountable Care Organization, or an ACO, is made up of physicians and healthcare facilities that collectively attempt to provide seamless care to those who fall under the Medicare umbrella, especially the ones who are suffering from chronic illnesses. Such an arrangement is also meant to curtail medical resource wastage resulting from unnecessary service repetitions and errors. An ACO is, therefore, expected to walk a tightrope, balancing both the standard of care and the amount of money spent on it in such a way that neither aspect takes a hit. While the quality of care is of primary importance, keeping a check on the corresponding costs is also vital. To be able to achieve both these goals successfully, an ACO should have the following features:
- An Advanced EMR System – A robust medical record system that stores information related to patient care and makes it easily accessible throughout the ACO, can help members track and manage care in a more organized manner. Such a system not only ensures the availability of data when needed but also feeds advanced data analytics tools that can help providers anticipate complications and take precautionary measures well in time to avoid them.
- A Cohesive IT Infrastructure To Support Analytics And Reporting – ACOs are collectives and, therefore, they are bound to have members and participating entities that use different systems for data storage and processing. It is essential to establish a central warehouse that pulls all the data from these varied sources and acts as a common platform for members. All the projects that are subsequently implemented as part of the ACO will derive data from this unified source.
- An Emphasis On Compliance – The compliance parameters laid out for ACOs are much more complicated than those for independent healthcare facilities and providers. It is, therefore, all the more crucial for such organizations to understand the nuances of the guidelines set by CMS and adhere to them to avoid penalties.
- An Integrated Approach – A group practice that integrates all kinds of clinical services and care by offering several specialties under the same roof can act as a very effective ACO. In such an organization, a team-based approach is adopted by administrative staff as well as providers to provide a hiccup-free experience to the patients.
- A Strong Focus On Patient-Centered Medicine – A successful ACO continuously strives to improve the level of customer service as any slip-up in this area can lead up to poor health outcomes.
- Employing Proactive Techniques To Cut Costs And Improve Outcomes – Utilization Management, Case Management, and Disease Management initiatives can all help ACOs improve their success rate by targeting potential issues before they blow out of proportion.
- Establishing A Claims Assessment – Reviewing claims that are being submitted and keeping a close check on the expenses incurred by participating PCPs, specialists, and facilities is critical especially in case of large ACOs.
- Promoting Better Internal Communication – A tight-knit organization that encourages the smooth flow of information between members can prove to be much more successful than others. It is crucial for participating members to have excellent working relationships to work collaboratively to achieve the best possible results for their patients.
- Providing Ancillary Facilities – An ACO that is self-sufficient as it also provides services like rehabilitation, DME, pathology labs, radiology services, and part B drugs has a higher likelihood of saving healthcare dollars and improving results.
- Incentivizing Physicians For Cost-Effectiveness – Rewarding those who practice the principles of optimum fund utilization, evidence-based care, overhead reduction, and perfect customer service is an excellent way to ensure the success of an ACO.
- Standardizing Policies And Procedures – It is essential to have clear policies and procedures that govern all aspects of an ACO to guide members properly and prevent compliance-related errors.
A well-structured ACO is a great asset to any community as it provides coordinated care to those who need it the most. Besides, by focusing on cutting costs, an ACO can pull down overall health care costs that are threatening to cripple the economy if left unchecked.