Accountable Care Organizations (ACOs) have experienced tremendous growth over the past few years with the total number of ACOs nearly doubling between 2013 and 2016 (see graph below). A recent article published by Health Affairs recapped the growth and progress of the ACO market since its inception, and the challenges highlighted by this article demonstrates that Chronic Care Management (CCM) will play an important role in the success of future ACO growth.
ACOs Over Time
ACO Growth Locations
First to recap more of the findings – as expected, the states with the highest number of ACOs were those that have the largest Medicare populations (e.g., Florida, California, New York); note that the article refers to ACOs across all payers, not just Medicare.
However, as a percentage of patients, the penetration into even the Medicare dense states (such as Florida) is relatively small (often less 10%). Hence the ACO market is still relative untapped in most states, including those states with large Medicare populations. This market could be captured by increased coverage by existing ACOs or by the creation of new ACOs, with smaller amounts of covered lives.
The key theme is that the market is still relatively nascent; ACO growth in terms of covered lives has been exponential, with covered lives increasing nearly 10x since 2013.
ACO Lives Over Time
Challenges Faced by ACOs
What does all this mean for CCM? The article goes on to highlight some of the challenges that ACOs face:
“Historically clinicians have operated relatively autonomously with a one-to-one, patient-provider relationship, with someone else left to worry about the overall population consequences. With provider organizations increasingly focused on population-level results, that mentality is changing to include a many-to-many approach involving a group of providers that must collectively work together to manage a population of patients. Changing the fundamental practice of medicine takes buy-in, effort, and significant time to accomplish.
For example, to effectively manage a population, a successful ACO must first understand their population, which requires developing and using health information technology (IT) in new ways. Selecting, implementing, and maintaining connected electronic data to support population health platforms remains a challenge, with both providers and the vendors creating new products and refining data-sharing and analytic technologies.
More importantly, ACOs must learn how to identify key data and act on it in a way that measurably improves the care of their population. Aggregating the data is technically challenging, but effectively prioritizing and operationalizing findings is a new skill set that providers are being forced to develop — and better health IT and analytics is only one of the many new capabilities that health care providers must develop to improve population health.”
Chronic Care Management and ACOs
CCM is the bridge to help providers make the leap fee for services (FFS) to value-based payment models such as the ACO model. Chronic Care Management programs allow providers to aggregate patient encounter information from across the entire continuum of care which gives them the tools they need to provide accurate and effective care. Critical to this process is the use of a state-of-the art population health technology that enables providers to effectively parse through large amounts of clinical data (as described by the article), identify patients at risk, and close gaps of care. This type of technology is simply not available through most commercial EMRs. Even those EMRs with CCM modules, do not have the sophistication required to manage these patients at scale. However, using CPT 99490, providers can generate a new revenue stream to help fund the use of advanced population health technology and, just as importantly, the associated clinical staff to improve quality of care and achieve shared savings for their ACO.
See full study below: