What is an accountable care organization?

Accountable care organizations (ACOs) were developed as a way to emphasize accountability among healthcare providers, moving away from the fee-per-visit model and toward value-based care. First coined in 2006, the term was used by Dr. Elliott Fisher during a meeting with the Medicare Payment Advisory Committee (MedPAC), in which he and others “argued that in order to significantly improve quality and costs, accountability for a patient’s care should be shared among all providers along the health care continuum.”

The Centers for Medicare & Medicaid Services (CMS) Innovation Center defines an ACO as a group of “doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.” ACOs also involve shared responsibility for the cost of healthcare. Through various CMS programs, independent physicians who participate in ACOs are able to potentially share in the savings of that cost with Medicare.

CMS Innovation further explains that “when an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.” Establishing strong partnerships with other physicians within the ACO and coordinating services can result in increased savings for all.

ACO programs within Medicare include:

  • Medicare Shared Savings Program (cms.gov) – For fee-for-service beneficiaries
  • ACO Investment Model – For Medicare Shared Savings Program ACOs to test pre-paid savings in rural and underserved areas
  • Advance Payment ACO Model – For certain eligible providers already in or interested in the Medicare Shared Savings Program
  • Comprehensive ESRD Care Initiative – For beneficiaries receiving dialysis services
  • Next Generation ACO Model – For ACOs experienced in managing care for populations of patients
  • Pioneer ACO Model – Health care organizations and providers already experienced in coordinating care for patients across care settings

ACOs are growing in number since they were first established after the Affordable Care Act of 2010 was put into place. There are now ACOs in all 50 states.

Prabhat Dhar
October 1, 2018


MSSP 2017 ACO results released

The Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) is offered to healthcare providers as “an opportunity to create a new type of health care entity, an Accountable Care Organization (ACO).” The program is voluntary and is designed to enable “providers to come together as an ACO to give coordinated, high quality care to their Medicare patients.” MSSP offers several tracks for ACOs to “assume various levels of risk” with the potential to share in the cost savings.

CMS recently released data for 472 ACOs participating in MSSP and caring for 9 million beneficiaries in 2017. Generally, the results were positive. More than half of the ACOs saved money and a third earned sharing savings. Both figures were increases from the 2016 participation results.

The National Association of ACOs (NAACO) released a summary of key data points found in the CMS MSSP report:

  • $1.1 billion in gross savings
  • Gross savings were generated by 60 percent of ACOs
  • $800 million in shared savings bonuses paid to ACOs
  • 34 percent of ACOs earned shared savings bonuses
  • $314 million in net savings to Medicare (after accounting for bonuses paid to ACOs)
  • A mean quality score of 90.5 percent for ACOs under pay-for-performance measurement

The net savings to Medicare of $314 million consisted of $291 million from those ACOs participating in Shared Savings only (Track 1) and $23 million from those ACOs participating in Shared Savings/Losses (Track 2 and 3).

While the results were positive for ACOs for 2017, new CMS proposals may “deter new entrants to the Medicare ACO program,” according to NAACO. While ACOs now have up to six years to prepare for taking financial risks while in the MSSP, a proposed rule would shorten the time in a shared savings only model to two years. In addition, CMS has proposed cutting the amount of shared savings in half, from 50 percent to 25 percent for shared savings only ACOs.

Prabhat Dhar
September 25, 2018


Tips for finding the best population health management solution

Population health is a relatively new concept but is growing in popularity and importance, with the move toward value-based care. Population health management essentially means tracking the healthcare data in a specific population of patients, being accountable for the health outcomes of that defined population, and providing positive outcomes at the lowest possible cost.

Population health management requires a set of tools that enables the independent physician’s practice to be efficient and organized enough to manage the patient data and provide those positive outcomes. Sometimes that means outsourcing the management tasks to a population health management company.

Health IT Analytics offers several tips for finding the best population health management solution, emphasizing that “understanding patterns of risk and acting proactively to avoid expensive health events are crucial for success in a value-based world.” Tips include:

Create a goal-oriented roadmap. The goal for population health management will be different for each independent physician, depending on the physician and the patient population. Accessing data from electronic health records (EHRs) can help the provider in identifying the specific goals for the practice and for the patient population.

Map population health goals to specific health IT capabilities. Population health management solutions, either standalone or as part of an EHR, must enable one or more of the following capabilities:

  • Data aggregation
  • Data analytics
  • Reporting and visualization
  • Care management and care coordination
  • Patient engagement

Identify vendor-customer partnership values. When choosing a population health management vendor, the independent physician should consider a number of factors that will impact the relationship. Research at the beginning to ensure the values mesh will improve the success of the partnership long-term. The provider should investigate the vendor’s operations in terms of:

  • Sales and contracting
  • Implementation and training
  • Upgrades and optimization
  • Customer service and support
  • Dispute resolution

Ask for peer recommendations. Population health management is gaining in importance as independent providers become more focused on value-based care. When investigating potential health management solutions, it’s always a good idea to learn from those who have gone before and to seek out their lessons learned from their vendor experiences.

Prabhat Dhar
September 24, 2018


5 tips on closing care gaps

Collaboration and electronic health record (EHR) interoperability are key factors in closing the care gap that exists among healthcare providers. Sharing information, in real-time, about a patient’s diagnosis and treatment plan can be crucial to a quality outcome for that patient. A recent report, Closing Gaps in Care through Health Data Exchange, points out that providers “are unable to efficiently identify patients in need of healthcare services or deliver services according to evidence-based guidelines in a timely manner.”

The report is the result of mixed methods qualitative research conducted by the Louis W. Sullivan Institute for Healthcare Innovation, in close collaboration with GE Healthcare. It “provides an overview of current approaches, best practices, emerging opportunities and barriers to identifying, preventing and closing gaps in care through data exchange via health information technologies.”

Emphasizing the need to close care gaps, which are defined as “the discrepancy between evidence-based recommendations or best practices and the care that is actually delivered,” the Sullivan Institute report points out the following five tips:

  1. Greater education and communication are needed to raise awareness among stakeholders, particularly providers, about the value of identifying and closing gaps in care.
  2. Gaps in care can threaten the performance of healthcare organizations.
  3. Gaps in care programs have had a positive impact and seem to produce a high return on investment.
  4. Consensus is needed to develop and standardize quality measures and methodologies for information exchange among health plans, providers and patients in an actionable manner. The report also stipulated that additional key technical barriers to exchanging gaps in care information include the provenance, quality, completeness, timeliness, transparency and accuracy of data.
  5. Addressing gaps in care is a critical issue for stakeholders that grows in importance as value-based care efforts mature and health insurance coverage access and care increase.

Prabhat Dhar
September 18, 2018


The importance of organizational alignment

A group of healthcare providers was recently asked, as part of a larger survey, for their top two reasons that alignment is important to a healthcare organization. Better patient outcomes and organizational stability were overwhelmingly the top responses. The survey was conducted of NEJM Catalyst Insights Council members – “a qualified group of U.S.-based clinical leaders, clinicians, and executives who are directly involved in health care delivery.”

Participants in the survey differed somewhat as to their top reasons, although “all segments of the Insights Council agree that organizational alignment is most important to achieve better patient quality outcomes.” The percentage of those saying that the top reason for alignment is organizational stability in a dynamic, changing health care marketplace were: clinical leaders (65%), executives (60%), and clinicians (48%).

Perhaps not surprisingly, more clinicians participating in the survey (26%) than those executives participating (14%) also said that organizational alignment is important for satisfaction among frontline clinicians.

When asked what is meant by the term “organizational alignment,” more than half (57%) of the clinical leaders and executives participating in the survey said that alignment is “the organization’s mission, vision, and goals…supported by governance, strategy, and incentives.” Just over a third (37%) of the participating clinicians chose this definition. Clinicians (17%) were more likely than executives (9%) and clinical leaders (7%) to say that alignment is achieved when “all functions of the organization are directed toward patient care.”

Almost all of those participating in the survey (99%) said that alignment is necessary for key stakeholders within the healthcare organizations. However, only 63% of the Council members reported that this alignment exists within their own organizations, identifying the gap as being highest among frontline clinicians and top executives such as the CEO.

The survey was conducted of 655 NEJM Catalyst Insights Council members.

Prabhat Dhar
September 10, 2018


Why EHRs are embracing comprehensive health records

Electronic health records (EHRs) are replacing paper medical records as a more efficient way to maintain patient data. Independent physicians who use EHRs realize a reduced potential for errors and spend less time searching through paper files for information. The next step in the progression toward optimizing healthcare through technology is the comprehensive health record.

Many patients see more than one physician, undergo diagnostic tests, or need treatment in a healthcare facility other than the independent practice. In order for the primary physician to efficiently coordinate patients’ care, records of the external providers should also be easily accessible. That is one of the main reasons that EHRs are embracing the concept of comprehensive health records.

The Northern Arizona Regional Behavioral Health Authority, Inc., now known as the NARBHA Institute, defines a comprehensive health record as a “new term to describe records with even more information than EHRs. Further, the comprehensive health record contains “all communications related to a patient’s physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of evaluation or treatment, including records that are prepared by a health care provider or by other providers.”

Elation Health’s Collaborative Health Record provides the same coordinated information for independent physicians. Rather than waiting for phone calls or faxes, Elation’s CHR enables you to automatically share updates directly from your Clinical EHR. Other providers get immediately notified so they can take action based on the most up-to-date clinical information.

In healthcare, time can be a significant factor in patient outcomes. Efficient collaboration with all of a patient’s providers can make the difference when confirming a diagnosis or determining a treatment plan. The Elation CHR digitally link a patient’s entire care network, improving care coordination and the quality of care everyone on the team is able to provide. Working across systems, CHRS are designed to enable each provider caring for a patient the access to information needed to care for that patient properly.

Prabhat Dhar
July 3, 2018


What is a clinical charting tool?

Documenting a patient’s medical history, visit notes, and treatment plan is an often time-consuming but always necessary part of treating that patient. There are a number of methods the independent physician can use for recording this information. Paper files are the traditional way to keep patient records. A clinical charting tool, such as that found in an electronic health record (EHR) can help the independent physician be more efficient and help ensure patient records are more accurate.

Medical records kept on paper in file folders can get lost or damaged. The independent physician searching for information within those records spends valuable time flipping through a stack of papers for the one piece of patient data that could make the difference in a diagnosis. When a specialty provider or laboratory is involved in the patient’s care, requesting and waiting for those records can create problems for both patient and physician.

An EHR’s clinical charting tool makes those records available to the independent physician and to clinical staff with the touch of a screen. Easy access to the patient’s medical history and notes input by other healthcare provides gives the physician more time to spend with the patient during the visit.

Elation Health goes one step further, providing templates for the physician to use that encourage consistent workflows across providers and staff by clearly laying out the steps and questions to be addressed. Independent physicians can export more than one template into a visit note at once to allow for more time-efficient customization. Users can include CPT codes and billing items into Elation’s templates to streamline visit note sign off. In addition, physicians can associate document tags for easier and more consistent reporting.

Another time-saver for the physician is to empower the clinical team to input a patient’s medical information into the EHR. For example, a medical assistant can use the clinical charting tool to update the patient’s record. With the assistant in the room during the visit, documenting the physician’s notes in the clinical charting tool, the physician can focus more fully on the patient, enabling better outcomes for patient and physician.

Prabhat Dhar
June 12, 2018


What role does the EHR play in facilitating collaboration among providers?

Patients who are elderly, who have chronic or complex conditions, or who need specialty treatment for a one-time medical event will typically see multiple physicians. These patients may need laboratory tests, x-rays, and perhaps even stays in a healthcare facility. Coordinating this care for the highest quality outcomes for the patient requires collaboration among the healthcare providers.

Waiting for phone calls or faxes can be time-consuming and possibly even dangerous for the patient’s condition. When care is not collaborated, errors of omission or duplication can also be dangerous for the patient. Collaborating in real-time can not only save time and money but can also significantly improve the outcome for the patient.

For those patients with chronic diseases, in particular, treatment “involves changing lifestyles and navigating a complex web of treatments. Different health care professionals with different skills in different locations will need to collaborate to provide a cohesive care team.”

Electronic health records (EHRs) can play a pivotal role in facilitating that collaboration among the multiple healthcare providers treating a patient. Physicians who have access to a patient’s EHR can immediately review the patient’s medical history, lab results, and other relevant information.

Elation’s Collaborative Health Record (CHR) closes the care gaps for multiple healthcare providers treating the same patient. The CHR decreases duplicative testing and enables providers to avoid medication errors with uninterrupted communication. The timely sharing of patient information helps ensure that care is as efficient as effective as possible.

Providers can automatically share updates directly from the Clinical EHR. Other providers are immediately notified so they can take action based on the most up-to-date clinical information. In addition, each physician has visibility into the patient’s complete care record for more accurate reporting on clinical quality measures and compliance for value-based reimbursement.

With the CHR’s intuitive search bar, it is easy to make sure the problem list, medications, lab results, and notes are always kept current. Ensuring that medical information is up to date and accurate, using an EHR to collaborate, can dramatically improve the outcomes for the patient.


Prabhat Dhar
May 22, 2018


Why patient engagement is key for bundled payments

Communication and engagement can help independent physicians overcome many of the challenges associated with bundled payment programs. The Centers for Medicare & Medicaid Services (CMS) has implemented two bundled payments, Bundled Payments for Care Improvement (BPCI – a voluntary bundled payment program) and Comprehensive Care for Joint Replacement (CJR – a mandatory bundled payment program). These programs are part of the CMS move toward value-based care and require physicians to more proactively plan and follow up on their patients’ care.

Rather than reward and reimburse independent physicians for the quantity of patient visits, which can also create fragmented plans that are not coordinated between providers, CMS is moving toward a focus on the quality of a patient’s total care. Towards this end, “bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners – allowing them to work closely together across all specialties and settings.”

Many independent physicians have expressed their concerns about how to make the bundled payment programs work for their practices. The key is engaging patients, which has the added benefit of improved outcomes for the patient, and maintaining communication with the patient and other providers during the entire care episode.

Proactively and creatively engaging with the patient throughout the care process can help the independent physician plan for the patient’s needs more effectively and more efficiently. Using technology such as electronic health records (EHRs) can also assist the physician in understanding the patient’s complete medical history, coordinating with other physicians and healthcare facilities treating that patient, and communicating with the patient before and after visits.

As a recent MedCity News article points out, “there are countless interaction points where providers can engage patients in their own care to lower costs, improve outcomes, and enhance experiences.” Patient engagement is the key for independent physicians’ success with the bundled payment programs.

Prabhat Dhar
May 14, 2018


What ACOs should consider when building partnerships with independent physicians

The core premise of Accountable Care Organizations (ACOs) is to “assign responsibility for a population of patients to health care providers, with payments depending on the cost and quality outcomes for that population,” as described by Managed Care. Participating in an ACO is voluntary for providers; however, the Centers for Medicare & Medicaid Services (CMS) has identified savings programs in which ACOs can share.

An ACO is formed by a group of independent providers. The ACO may find, though, that it needs to find new partners to fill a gap in medical service capabilities. When building partnerships with independent physicians, an ACO should consider a number of factors. While ACOs offer incentives for quality healthcare, they must “recognize the needs of their assigned populations and work to provide comprehensive care management across the spectrum of provider types.”

Recent research published in Managed Care suggests that “ACOs need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.” That framework includes seven “high-value” elements to look for in potential partners:

  • Patient-centeredness
  • A culture that emphasizes value
  • Accountability
  • A team-based approach
  • High-functioning health information technology systems
  • A quality assurance system
  • Financial preparedness for value-based care

The research involved interviews with ACO representatives as well as entities representing several different types of healthcare providers. Additionally, an expert panel was convened to “evaluate the framework and help prioritize provider types to evaluate.”

Managing care appropriately and in line with the move toward value-based care requires coordination across providers of different types and specialties. An ACO that can build effective partnerships with independent physicians based on the framework identified in the research “may allow providers to expand their influence throughout the delivery system as they begin to work across locations and episodes of care to manage population health.”

Prabhat Dhar
April 11, 2018