In an effort to lower costs and experiment with different incentives and systems, CMS created several programs to promote coordination within the healthcare system and improve the quality of care for chronically-ill patients.(1) As part of Medicare’s transition from volume-driven care to value-based care, the Accountable Care Organization (ACO) model provides incentives for healthcare providers to promote quality over quantity.(2) This effort is supported by the American Medical Association, because the organization understands that ACO success encompasses much more than cost-savings.(3) With a focus on systems to improve patient care, ACOs are well-situated in a consumer-oriented market.
Over the past decade, CMS has argued that providers will increase quality of care when they share in savings from better-coordinated preventative, diagnostic, and therapeutic services. As a result, ACOs are responsible for providing their patients with healthcare management services. In order to realize the benefits of cost-savings through evidence-based healthcare management strategies (e.g. vaccines, flu-shots, cancer screenings, Annual Wellness Visits, etc.), they must furnish their patients with management services. Consequently, partnerships with a third party, such as CareHarmony, are an effective way to provide these services.
Medication Use Practices: An ACO Success Story
ACO success is most prominent in the optimization of medication use practices. As CMS shifts to non-monetary evaluations, medication adherence is a common metric utilized to track progress. Recent reports have confirmed that ACO achievements are strong in this area. Some examples are:
- increase in patient education
- integration with pharmacy systems,
- increased appropriate use of generic medications
- the development of better systems to track preventative care gaps
- an increase in electronic transmission of prescriptions
- the creation of better systems for potential adverse-events notifications(4)
Because ACOs are created with an emphasis on collaboration, streamlining many aspects of medication use is a logical first step.
Although they are largely successful with these substantial improvements, ACOs still lag in a few areas. For instance, pharmacy notifications for cancelled prescriptions are slow. In addition, ACOs continue to encounter problems with delivery of discontinued prescription notifications to care providers. Much of these delays in implementation can be attributed to technological barriers, reimbursement methods, and reporting difficulties.(4) In other words, medication use practices are changing for the better, but there is still room for improvement.
Other Strategies for ACO Success
The ACO model is advantageous in other areas, as well. ACO success is most notable in the reduction of duplicate services and readmissions. This has yet to translate into large savings, but many experts say that it is too early to assess. The goal is to maintain and even increase quality of care, while lowering costs. Therefore, the focus is on the former as methods and strategies are tested. Any analysis of these programs must consider experience. Implementing new methods, purchases of new technology, as well as training and increasing staff are costs associated with shifts in policies. Older programs demonstrate increased savings, which CMS says is expected.(5)
CareHarmony: For Faster Implementation and Lower Start-up Costs
The greatest barriers to ACO success are start-up costs and staff positions to perform Chronic Care Management (CCM). ACOs face increased initial costs in healthcare IT and staffing.(6) As such, many ACOs are looking outside of their organizations to contract with third parties, such as CareHarmony. With healthcare IT and trained care coordinators already in place, CareHarmony offers a faster path to implementation.
Second, although ACOs have accomplished much in traditional healthcare services, they are still inadequate as key support service providers. Frequently, social components prevent treatment plans from being effective. For instance, issues with food and housing insecurity and lack of transportation are social barriers to healthcare that Medicare patients face.(7) CareHarmony facilitates the connections these patients need to local and federal resources that ameliorate obstacles to good health outcomes.
Chronic Care Management and ACOs
As CMS increases its efforts to shift from fee-for-service models of payment to value-based care, membership in new programs, like ACOs, is essential to remaining a viable, Medicare provider. CareHarmony is positioned to help healthcare groups integrate these programs into their practices. CCM increases medication adherence, provides connections to social services, and increases appointment compliance. All three of these services are components of CMS’s evaluations of ACO success. By collaborating with CareHarmony, ACOs can quickly, and cost-effectively, provide their patients with high quality chronic care management they need.
- Centers for Medicare & Medicaid Services, “Accountable Care Organizations (ACOS): General Information,” 2017, June 15. [Online: June 16, 2017] https://innovation.cms.gov/initiatives/ACO/
- Staff, “Feds: ACO Regulations Will Tie Quality to Savings,” MedKnight’s 2011, April 01. [Online: June 16, 2017] http://www.mcknights.com/news/feds-aco-regulations-will-tie-quality-to-savings/article/199752/
- Staff Writer, “New Medicare Shared-Savings Model Friendlier to Small Practices,” AMA Wire, 2017, May 22. [Online: June 20, 2017]. https://wire.ama-assn.org/practice-management/new-medicare-shared-savings-model-friendlier-small-practices
- National Pharmacy Council and Leavitt Partners, “Optimization of Medication Use at Accountable Care Organizations,” Journal of Managed Care & Specialty Pharmacy, 2017, May 30 [Online: June 19, 2017]. http://www.jmcp.org/doi/full/10.18553/jmcp.2017.17100
- Bryant, Meg, “Is Value-Based Care Making a Difference?” HealthcareDIVE, 2017, June 7. [Online: June 19, 2017]. http://www.healthcaredive.com/news/is-value-based-care-making-a-difference/444244/
- Sanberg, Shana, et al. “Evolving Health Workforce Roles in Accountable Care Organizations,” American Journal of Accountable Care, 2017, June 12. [Online: June 19, 2017] http://www.ajmc.com/journals/ajac/2017/2017-vol5-n2/Evolving-Health-Workforce-Roles-in-Accountable-Care-Organizations
- Romm, Iyah and Toyin Ajayi, “Weaving Whole-Person Health Throughout An Accountable Care Framework: The Social ACO,” HealthAffairs, 2017, January 25. [Online: June 19, 2017] http://healthaffairs.org/blog/2017/01/25/weaving-whole-person-health-throughout-an-accountable-care-framework-the-social-aco/