In the initial shift to value-based care, most health systems focused on improving internal processes, in-house spend, and closing care gaps inside their own organizations.
This is especially true of Accountable Care Organizations (ACOs). These organizations largely used internal risk and cost analyses to lower expenses. There was also a learning curve associated with the early days of the ACO program.
“The first Medicare ACOs after Pioneer ACOs had multiple tracks,” said Saqib Akhter, CEO of Post Acute Analytics, “Track one was an upside-only model, which means if you saved money you got a percent of what you saved, but if you lost money there was no downside. So, that is where majority of the health systems were. If you look at other tracks that had downside sharing, there were fewer participants.”
However, that’s changing with the introduction of the Next Generation ACOs (NGACO). This program is designed for organizations that are confident in the ability to control costs while providing expert care. There is no upside-only model. Organizations that falter will take a financial hit.
This means that ACOs can no longer only rely on improving care and lowering costs within their walls. Since one of the greatest areas of variable healthcare costs is in the post-acute setting, ACOs need to focus their attention on post acute to control costs.
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Research shows existing ACOs have had success in controlling post acute costs. A recent review of the Medicare Shared Savings Program (MSSP) published in the JAMA Internal Medicine found that ACOs achieved a nine percent reduction in “waste spending associated with post-acute care” when compared with local nonparticipating healthcare professionals. According to the report, “Spending reductions in post-acute care were achieved without ostensibly compromising or improving the quality of care for ACO patients, based on mortality, readmissions, and use of highly-rated skilled-nursing facilities.”
NGACOs will need an even deeper understanding of their patients and real-time insights to impact patent quality over an entire healthcare episode.
“The first thing you want to know is if your patient ever lands in a post-acute setting,” said Akhter. “You want to know that immediately. Second, you want to be able to track their progress in the post-acute setting. Are they getting better or worse? How is their risk evolving in real time? How long have they been there and is that considered on track relative to their care plan? You want to be able to intervene in real time. Third, you want to know where they are going from that post-acute setting. Because you want to make sure they are going to the most appropriate setting and being discharged safely.
“Additionally, all of this information has to be completely automated. No one in healthcare has time for manual data entry. It also needs to be intuitive and actionable so providers know within seconds which patients need attention.”
Fortunately, a solution exists that enables healthcare systems to monitor their patients as they move through the post-acute setting.
“Currently, health systems have very limited data that is delayed, not risk adjusted, and is not specific to their patients. The data that Post Acute Analytics provides is in real time, risk adjusted for acuity of patients, and based on the ACO’s patients in a fully automated fashion,” said Akhter.
“Being able to look at the data for only that hospital’s patients is important because the hospital can look at specifically what metrics are impacting them as it relates to readmissions, Medicare expenditures per beneficiary, bundle payments, MACRA, and NGACOs.”
“There are post-acute providers that are taking more complex patients with a greater number of core morbidities, and as a result they are naturally going to have tougher outcomes because they are taking care of sicker patients. So, an apples-to-apples comparison is essential to risk adjust for the acuity or sickness of patients that post-acute providers are taking.”
What happens outside of a health system is an increasingly crucial point of concern. How ACOs and other healthcare systems work with their post-acute providers must evolve to ensure quality care while lowering costs.