Rob Mechanic: Identifying Patients Who Could Benefit From Holistic Care Is a Work in Progress

Rob Mechanic, MBA, senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Institute for Accountable Care, discusses how well accountable care organizations (ACOs) and other healthcare organizations are able to identify patients who could benefit from more holistic approaches to care.

How well are ACOs and other healthcare organizations identifying high-need patients who could benefit from more holistic approaches to care?

This is a really important issue. I think for ACOs and other organizations, it’s easy to identify people who are high cost, but as you know, high-cost patients over time tend to be less costly just because they’re high cost because they had an acute episode. The trick is identifying people who are rising risk who are likely to be more expensive. The other big issue in this high-need, high-cost population is that a lot of times the costs are driven by social factors—lack of adequate housing, lack of adequate food, inability to get transportation where they need, they don’t have jobs. One of the big important things for ACOs focusing on these populations is also to address the social determinants.

I would say ACOs have a lot of different tools. The main tool is they usually do some analytics where they’re looking at historical claims data and there is also clinician referral. I would say they do it ok, but it’s a really hard thing to do and it’s going to be a work in progress.