Accountable Care Organizations to Expand Their Scope of Reach

Accountable care organizations (ACOs) are seeking to expand population health management capabilities through relationships with community organizations and patients, according to a new report.

Premier Inc. released the report titled “How ACOs are Addressing Population Health” with support from the Robert Wood Johnson Foundation, in conjunction with Greenwald & Associates, LLC, National Research, LLC, and KNG Health Consulting, LLC. The authors compiled the report after studying qualitative and quantitative information from 19 fully integrated ACOs.

“Alternative payment models, such as ACOs, serve to shift the traditional fee-for-service model, which incents providers to do more rather than do better, to a value-based model that aligns incentives with measurable quality, cost and population health outcomes,” said Timothy Lowe, PhD, director of healthcare research at Premier Research Institute and the study’s principal researcher. “As providers develop and implement alternative payment models to align with value-based payment policies, such as the new Quality Payment Program for physicians, it is critical to identify what is working and what is not to support continuous change and improvement.”

Limitations and Challenges

Data collection through telephone interviews from 19 participating ACO took place between Sept. 2015 and April 2016. Based on the health survey the participants provided, a number of challenges were highlighted.

For example, while most ACOs worked with community social service organizations, 84% sought increased support from their community partners rather than sticking to traditional hospital-based organizations. This includes:

• Serving as the central hub to enable community organizations in meeting the needs of mentally ill and chemically addicted patients
• Teaming with employers and local gyms to offer exercise and nutrition-based counseling to address preventative health needs.

Additionally, some ACOs struggle with financial pressures. For example, only 32% of the participants admitted to possessing the adequate resources to meet the challenge of improving community health.

Other limitations include:

• Inadequate funding for staffing and services
• Data inter-operability challenges
• Physicians operating under the fee-for-service model
• Payer pressures

Developing a Better Care Model

Ideally, ACOs are designed to shift the traditional, fragmented, fee-for-service model of care delivery to a new model based on shared accountability for measurable quality and cost improvements. However, the final results have fallen short of expectations. Modifying the ACOs to transform the entire U.S healthcare system would require expanded collaboration between patients, primary care physicians, physician specialists, hospitals and other care providers.

The report presents the following solutions to meet the ongoing and future challenges:

• Improving information and best practice sharing with other ACOs
• Developing a framework for implementing population health improvement activities based on level of maturity and access to required community resources
• Enhancing dialogue between providers, regulators and funders to set priorities for services development and future research foci

“This analysis reveals real-world efforts underway when it comes to the importance of community partnerships to influence health outcomes and performance,” said Joe Damore, vice president of population health management at Premier. “We’re seeing our members collaborate with organizations like Meals on Wheels to improve the health of their populations.”