Lessons Learned from Accountable Care Organizations on how to Drive Value

Post Written by Luisa Fernandes, Senior Research Analyst

HSG is a proud sponsor of Health Care Value Week. Missed the great content this year? We have you covered, with a series of top takeaways from the week of dynamic conversations.

This year’s Health Care Value Week provided interesting and rich opportunities to all interested in advancing quality of care, patient satisfaction, and fair payment systems within the health care system to learn from what has been accomplished in the last decade of the move to value based care. One example of how value-based health pulls from the lessons learned of previous delivery system reform was on display with the panel discussion “How ACOs Improve Patient Outcomes: Lessons Learned After a Decade of Clinical Transformation.” organized by the National Association of ACOs (NAACOS).

Four panelists representing three different organizations of ACOs across the country highlighted their most important achievements. The panel was moderated by David Pittman, a senior policy advisor at NACOS, and the participant panelists were: Rick Foerster, Senior VP of Value-Based Care, Privia Health; Don Calcagno, Senior VP of Enterprise Population Health, Advocate Aurora Health; Chelsea Webb, Quality Improvement Manager, Baylor Scott & White Quality Alliance; and Jerica Dykes, Director of Comprehensive Care Management, Baylor Scott & White Quality Alliance.

Privia Health highlighted its ACCESS program, calling it a foundation strategy to value-based care, with the goal to address patient demands at the level of each one's convenience, ensuring access to care. Their experience proved that patients need to be proactively engaged, and value based organizations should worry about patients not seeking care or not answering to active engagement more than with patients seeking care. For that reason, their strategy includes offering an array of services and communication channels to ensure access, inclusion patient portal; Registration process through phone, portal, mobile app or in person, e-mail communication, telehealth consults, and others. Preference among patients is vast, and no one solution works for all of them; access needs to be addressed comprehensively.

Privia also invests in integrating value for providers and patients, creating workflows that allow information to be used at the point of care, and making care management reports accessible to providers on a day-to-day basis. That strategy includes having one unique portal login for providers, and their proprietary electronic health records across all organizations, into which is embedded their referral systems. The referral system is intended to be a referral decision support, where the provider can access a narrow virtual network for referrals, considering the patients' needs and the organization's reach. The network is curated based on secondary collected data (administrative and some qualitative data) combined with clinician inputs to support informed decisions.

Advocate Aurora Health attributed its national success and high interest in bundles to its consolidated infrastructure to manage VBC. Three axes f that infrastructure was highlighted: integrated care management, continuing heal, and Pharmacy Utilization Management.

Integrated care management includes inpatient and outpatient management with one single leader to increase communication. Their roles cover patient education, prioritization, and patient outreach based on predictive analytics and post-discharge follow-ups. They have observed reduced readmissions and ER visits and increased patient satisfaction with such a comprehensive strategy. Appropriately engaging patients based on available data is one of their priorities. A solid and high-quality standard SNF network can be used if and when needed, which is a guiding principle. The Continuing Health strategy is based on a sophisticated post-acute network with ten different care lines and a goal to keep the patient home. The new product launched here is the Hospital at Home project—a project that we should all be paying attention to.

Arora's Pharmacy Utilization Management Policy has been attributed to saving about $3.8 million, based on claims review and a strong incentivized biosimilar use policy whenever they are available. Claims review by pharmacists allows a discussion to determine the right drug and dosage and improve patient outcome or if there are alternatives.

Baylor Scott & White Quality Alliance highlighted their priority to provide the full continuum of care with a high-performance primary care network; comprehensive care management, support patients outside the clinical setting; tailored data report and analytic capability; and physician engagement infrastructure.

The physician engagement infrastructure is based on an innovative VBC Star Rating Program. The program is used to evaluate the performance of providers and clinics, creates opportunities to share achievement, and facilitates sharing best practices; serves as a forum to discuss barriers providers are facing and develop solutions. The stars are a composed of measure selected annually, considering the existing contract measures, most recurrent measures across contracts, and clinical interests assessment to impact patient outcomes. Prioritizing is the key to building a good measure. Baseline data is essential to guide actions and drive performance of contracts. The process to engage physicians with the VBC star rating program includes data review, providing data access to all providers all the way to the patient level, continuing education through multiple channels, aligning program achievement with physician compensation, ensuring and equipped care management team for patient education, built a specialized community health workers network; and offer proactive outreaches to regional leaders and multidisciplinary team collaborators.

Another critical feature of their model is to improve communication between physicians, care management, and the multidisciplinary care team, which is done using a shared electronic medical record system.

The challenges faced when implementing this innovations were addressed during the session. Financing care coordination was a common challenge, considering the difficulties in substantiating the ROI. Aurora Health said they are developing an internal program to calculate ROI, and Privia Health referred to more advanced areas where care management has proven efficacy, such as behavioral health and chronic diseases management. However, it was a consensus that care management needs to be tailored to each patient's needs to provide ROI, not only general care navigation. 

Privia Health highlighted that one of the challenges to move from fee-for-service to value-based-payment was to create different programs to all levels of risks, maintaining diversity, and especially creating opportunities for primary care providers. Aurora Health also included that having one singular EMR across all organizations and providers is a challenge and a need, considering the relevance of collecting data, analyzing it, making it available to the point of care.