5 steps to solid infrastructure for ACO goals
Hospitals and healthcare systems unable to fully meet all of the Centers for Medicare & Medicaid's requirements for a Medicare accountable care organization still have the opportunity to participate in emerging models designed to provide care at a lower price.
Hays Green, healthcare policy practice lead at WPC, a Nashville, Tenn.-based company that provides consulting solutions, has outlined five preparatory actions that providers can kickstart today to create a solid infrastructure to achieve long-term ACO goals. "These steps can help organizations enter the commercial realm of accountable care models on level footing," Green said.
1. Determine organizational readiness.
What does your organization hope to gain from moving to a new ACO? Are your business partners demonstrating interest or a willingness to collaborate with other providers in an ACO arrangement within your geographic area? Consider the recent heat maps showing the concentration of ACO formation activity in the Midwest and Northeast regions. It's important to determine the primary issue as the underlying reason to form an ACO. Designate this concern as the core of the organization's ACO mission statement formation process as well as its internal communication plan to drive the transition.
2. Assess the personnel infrastructure.
Perform an organizational readiness scan to assess in-house players most fitting to contribute to the model. "Are the appropriate and willing executive leadership appointees designated and ready for board level leadership? Does your clinical staff include the appropriate mixture of primary care physicians, hospitalists, intensivists, internists, nurses, etc., knowledgeable of the new care delivery model?" asked Green. Convert current staff with applicable skill sets to care coordinators or health coaches, or hire additional clinical staff to fulfill open positions. "Health coaches can bring patient care plan management skills," he explained. "The health coach can also foster behavioral change in patients, particularly those with one or more chronic conditions." Forward-thinking organizations can recruit internal data management professionals to build a clinical data warehouse or mine existing clinical data for other Patient Protection and Affordable Care Act initiatives.
3. Analyze the technology infrastructure.
First, Green said, assess your financial systems. Is your organization able to accept and process risk-sharing, capitated payment methodologies? Does the financial system support one of the two CMS options for bundled payments under the new fee-for-service structure? Request demos of EHR systems to explore new functionality to manage the accountable care reimbursement models.
Second, assess your clinical systems. Can your enterprise/in-patient/ambulatory EHR system access the following features: Does your EHR application have inherent data warehouse capabilities? Is an external data application needed to process clinical data for measurement and business intelligence/analytics? Is the organization pursuing Meaningful Use compliance? What steps have been achieved or are currently underway to attest for Stage 1? "Explore regional or statewide health information exchanges to share data. Leverage the evolving patient portals to complete Meaningful Use Stage 2 criteria. Leverage EHR systems for communication intervention tool use," Green suggested.
4. Evaluate care delivery processes with focus on care coordination.
It's a smart idea to determine the care coordination techniques in place across the organization, and analyze how it occurs today. Determine if care teams are part of the organization. Find out if fax machine and spreadsheet combinations or EHR systems are used entirely for care coordination. Research whether each facility within the health system follows the same care coordination protocols. Test if the organization can adapt to a new care delivery model to foster better coordination. Decide which healthcare professionals will be responsible overseeing new care coordination techniques. Better care coordination enables increased patient engagement by increasing the quality of communications between clinicians, specialists and patients.
5. Formulate a communication plan for the cultural shift.
A communication plan should include the following messages: reasons and benefits of shifting from traditional fee-for-service to shared-risk reimbursement arrangements; why the organization elected to make the shift; and an explanation of how this shift will impact day-to-day operations. "It's important to emphasize how steps associated with this paradigm shift will enhance care coordination and patient engagement activities," Green said.
