Earlier this year, the Centers for Medicare & Medicaid Services (CMS) released an analysis of 114 newly formed Accountable Care Organizations (ACOs). Nearly half were able to cut costs for Medicare patients. Almost a third saved enough to qualify for incentive bonuses based on their success in providing more effective and efficient care.
These results are promising, but CMS acknowledges that the true impact of ACOs needs to be measured over several years. And, as the Wall Street Journal reported, these 114 ACOs faced significant challenges including technology investment and electronic health record sharing.
Charles Kennedy, M.D., CEO, Accountable Care Solutions from Aetna, offers his perspective on what makes ACOs work and what is needed to help them deliver on the promise of improving patient health.
Q: Why is technology critical to ACO success?
Dr. Kennedy: ACOs rely on a team approach to care. Technology allows the team, regardless of location, to share and act on patient information. The systems have to be interoperable, however. Many of today’s electronic medical records are not. They are more like electronic filing cabinets with limited ability to share data.
Sharing patient data is only part of the story. When we integrate patient-specific clinical and claims data and analyze it against evidence-based recommendations, we see a clearer picture of that patient. In addition, we can incorporate data directly from patients as part of a complete clinical picture. All of this information helps physicians identify opportunities to improve care, better manage chronic conditions, deliver timely preventive care and improve outcomes. With access to actionable, real-time insight, every member of a patient’s care team can achieve the triple aim: improved quality, lower costs and deliver a better patient experience.
Q: What role do patient tools like mobile apps and online resources play in making patients healthier and saving money?
Dr. Kennedy: Because ACOs are taking greater responsibility for the cost and quality of care within their populations, mobile health is key to patient engagement.
Mobile tools can help people find appropriate sources for health care within the ACO network. For example, many emergency room visits are avoidable. They happen because people lack support, information and guidance when they need to make this decision. Mobile applications – such as the iTriage app – give people guidance around potential causes and appropriate care.
Mobile health can also make it easier to interact with the care team. Apps that use secure, HIPAA compliant technology let people communicate with their doctors from their smartphones and tablets.
Mobile health monitoring devices are becoming important in the management of chronic disease. These devices can track and store biometric data. This can help ACO providers monitor the health of patients with chronic conditions such as diabetes and high blood pressure and reach out to them if their condition changes. In doing so, they may be able to reduce the likelihood of complications.
Q: What are some lessons from the CMS findings on ACOs?
Dr. Kennedy: The first lesson is that we are seeing early indications that ACOs are helping to reduce costs. Even though not all participants saved money, few initiatives have saved as much money without making dramatic cuts to benefits.
The second lesson is the importance of sharing patient health information. To coordinate care and improve health outcomes, ACOs need ready access to patient data. Doctors need to know who their patients are, their conditions, where they receive care, and if they are adhering to their care plans. Technology enables all of this.
Finally, the incentives for doctors and hospitals to participate have to be strong enough to offset the risk and investments these providers need to make in technology and new resources. However, that alone isn’t enough. Cutting costs only takes them so far. To ensure long-term success, health care providers need a sustainable and completely new business model designed around better patient outcomes.
Dr. Kennedy is also featured in the June issue of HealthLeaders Magazine http://www.healthleadersmedia.com/content/MAG-305443/New-Goals-New-Alliances