New Report Highlights Data-Driven Success Strategies for ACOs

A new report from the National Association of Accountable Care Organizations (NAACOS) shed light on the strategies that have driven the success of ACOs in adopting value-based care (VBC).

Based on in-depth interviews with high-performing ACOs, the September 2024 ACO Drivers for Success report outlines 5 core strategies for effective ACO management, including working across payers, fostering a high-value culture, leveraging data, implementing clinical interventions, and engaging patients.¹

Data integration, team-based clinical interventions, and other key strategies can enhance value-based care | Image credit: onephoto – stock.adobe.com

Over a decade ago, as Medicare shifted toward VBC, ACOs became central to payment reform, aiming to break the link between reimbursement and service volume while emphasizing patient outcomes. CMS set ambitious goals, aiming for the majority of Medicare beneficiaries to be in accountable care models by 2030.

These efforts reflect the need to shift from a reactive, high-cost “sick care” system to a proactive approach focused on population health, coordination across specialties, and reducing health care waste. In 2022, estimates suggested that health care waste contributed to 25% of total US health care spending, amounting to up to $935 billion.² By cutting this waste, ACOs can reinvest savings into transforming care delivery and improving patient outcomes.

Integrating Data Across Payers

One of the key strategies highlighted in the report is the importance of working across multiple payers.¹ Managing accountable care across various business lines or subsets of the population helps ACOs gain momentum and achieve greater financial and clinical success. However, navigating the inconsistencies between payers can be complex due to varied program designs and policies.

Operating in a multi-payer model, OneCare Vermont initially struggled to manage payer-specific data portals, which led to inefficiencies. They later shifted to a more streamlined system offering real-time, actionable data that prioritized key population health initiatives. With these changes, providers will soon be able to drill down to patient-level data and click on actionable items, like identifying patients in need of colorectal cancer screening. This more patient-focused approach shows the potential to improve outcomes by using integrated, comparative data to simplify workflows.

The key takeaway is that data should simplify provider decision-making rather than overwhelm them. Relevant, timely data helps clinicians prioritize care improvements and identify gaps in performance. Ochsner Accountable Care Network, for example, used data to address variations in how patients with wet age-related macular degeneration were treated. By creating an evidence-based care pathway, they reduced costs by over $5000 per patient without compromising quality.

Leveraging Data for Health Equity

Data also play a key role in addressing health equity. OneCare Vermont used a combination of claims and clinical data to identify food insecurity among their patients. This led to a joint initiative with a federally qualified health center that connected over 900 patients with food benefit programs, showcasing how data can be a tool for meaningful interventions that go beyond traditional clinical care.

Successful ACOs also use data to drive preventive care and manage chronic conditions. Coastal Carolina Quality Care analyzed iron-deficiency anemia treatments and discovered high spending on an injectable medication. By switching to a less expensive, off-label treatment and covering it through the ACO, they saved costs while maintaining patient satisfaction. According to the report, this combination of data-driven care redesign and cost control is a hallmark of high-performing ACOs.

Building a High-Value Care Culture

Establishing and maintaining a high-value care culture is another vital strategy for ACO success. Leadership must effectively communicate the importance of proactive, population-focused health care, ensuring that providers at all levels are aligned with VBC goals. For example, many ACOs are shifting funding toward primary care, recognizing that strong primary care leadership is the foundation of accountable care. Billings Clinic and OneCare Vermont have both implemented comprehensive primary care reforms to support care teams, integrating behavioral health and embedding social workers and pharmacists within primary care practices to foster collaboration and improve care coordination.

Team-based care, where primary care providers work closely with a variety of specialists, allows for more effective patient management and better clinical outcomes. This approach is particularly important as ACOs aim to improve total cost of care while ensuring seamless care transitions between specialists and primary care providers.

Clinical Interventions and Preventive Care

Clinical interventions remain central to VBC, and ACOs consistently use data-driven initiatives to optimize care. For example, UNC Health Alliance identified a spike in ER visits for dialysis patients on weekends due to a lack of transportation. They implemented a transportation benefit, dramatically reducing ER visits and improving patient health. Other interventions include fall prevention, cancer screenings, and chronic disease management, all designed to improve patient outcomes while lowering health care costs.

Engaging Specialists and Patients

As ACOs evolve, engaging specialists becomes increasingly important, but while engaging specialists in VBC is a top priority for ACOs, they face challenges doing so.³ Specialists play a significant role in health care spending, yet the report highlights that less than 10% of ACOs report high levels of specialist engagement in VBC initiatives.¹ ACOs must work closely with specialists to align goals, improve care coordination, and create financial incentives that encourage better performance on cost and quality measures.

In addition to specialists, patient engagement remains a critical focus for ACOs. Building trust and maintaining open communication helps ensure patients remain involved in their care. Efforts such as patient education, personalized care plans, and access to care tools such as 24/7 nurse triage lines encourage patients to take an active role in their health, helping ACOs achieve better outcomes.

References

1. ACO drivers for success. NAACOS. September 25, 2024. Accessed September 26, 2024. https://www.naacos.com/aco-drivers-for-success/
2. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501-1509. doi:10.1001/jama.2019.13978
3. Mechanic RE, Secordel L, Sobul S, Perloff J. Accountable care organization initiatives to improve the cost and outcomes of specialty care. Am J Manag Care. 2024;30(5):237-240. doi:10.37765/ajmc.2024.89536