5 Questions to Ask Before Joining an ACO
With the rise of value-based care, practices have the option to join accountable care organizations (ACOs). CMS describes ACOs as groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their patients.
Both public and private payers form ACOs for their respective populations, with the goal of ensuring that patients, particularly those with chronic conditions, receive the right care, in the right place, at the right time.
By facilitating the coordination of patient care between PCPs, specialists, and facilities, ACOs aim to reduce the overall cost of care for patients, and share the savings with you.
What are some things you need to think about before signing up?
Are you committed to change?
Joining an ACO entails making adjustments to patient care processes, including referral patterns, communication between specialists and PCPs, and visit documentation. You and your partners need to be sure that you’re prepared to adjust your and your staff’s workflows based on third-party input. In terms of day-to-day realities, shifting the way you engage with your patients can be the most challenging part of signing a value-based reimbursement contract.
Are you ready to data dive?
ACOs are all about population health management, and measure progress through multiple quality metrics and satisfaction benchmarks. Before signing on the dotted line, be sure that your practice has the tech infrastructure and staffing to be able to manage the inflow of patient claims data from payer sources and run internal data out of your EHR system. You’ll need to be able to interpret trends in that data and communicate internally within your practice when clinical and administrative process need to shift, which involves juggling dozens of individual metrics that might vary between payers.
Is the ACO ready to help you achieve savings?
Ask about the ACO’s health information infrastructure. You need to be able to understand the contents, frequency, and quality of data that you’ll be receiving from the ACO. At the very least, they should provide claims data regarding your patients who are attributed to the ACO, including information about services provided to patients from other practices and facilities, whether or not they also participate in that particular ACO. The ACO should also be able to provide you with information on patients who are at risk for acute events or high-cost conditions.
Is there downside risk?
When first starting on the journey to value-based care, be very careful that you’re not accepting downside risk too soon. Downside risk, in essence, means that you’ll be paying a penalty to the ACO if your patients’ healthcare costs increase, or exceed spending targets for the year. ACOs tend to offer higher bonuses for achieved savings if you’re also willing to take the risk of owing money if your practice adjustments don’t quite go to plan. It’s best to give yourself a few years to assess the kinds of changes that will be necessary to achieve savings, plan those changes, put them into action, then regroup and tweak until you’re seeing the results you want.
Are there other costs?
The ACO you join should be offering some level of infrastructure support to you and your partners (usually for data collection and/or reporting). It can also include staff for care coordination activities and establishment of best practice guidelines for your practice and other groups participating in the ACO. Make sure that you’re aware of how those costs are shared among participants, and if those are required as up-front payments, or are deducted from your shared savings distributions.
The shared savings programs offered by ACOs can be a powerful way to more efficiently care for your patients while also increasing your revenue, particularly these days when fee-for-service payments are rapidly dropping. Before you sign on, make sure that it’s the right fit for your practice.
Want to know more? The AMA offers some helpful resources HERE.