Revenue Cycle Management (RCM)

How to make successful Accountable Care Organization?

Value-based care is gaining more popularity in the US healthcare system and Accountable care organizations (ACOs) provide the main push for the healthcare industry away from fee-for-service towards value-based care.

ACO is a very interesting model for care where groups of doctors, hospitals, and other health care providers voluntarily offer coordinated, high-quality care to patients. The organizations achieve their goals with the help of a universal budgeting system and value-based reimbursement.

Moreover, through care coordination and a shared savings payment model, ACOs strive to improve patient outcomes and population health management while keeping costs to a minimum.

You can find many ACO models and there is no standard ACO model. For Example:- Some ACOs include specialists and hospitals while others focus solely on strengthening primary care services. However, each model has a nuanced funding structure and value metrics they report on, and contracts vary from group to group.

Moreover, clinically integrated networks (CINs) and ACOs are interchangeable because ACOs are moving away from a legal partnership and towards care coordination. All ACOs have only one goal i.e. deliver high-quality care for lower costs and many ACOs are following common strategies for earning shared savings payments and other value-based incentives while delivering high-value patient care despite their differences.

Strategies for successful accountable care organization:

Reducing out-migration from your ACO network

You should pay yourself first for the provided care than a competitor. It is impossible to provide everything to your healthcare consumers but make every effort to reduce the “leakage” of services you can perform. For example, establishing or increasing after-hours care can help to reduce ED visits.

You can find new opportunities for new lines of business by understanding higher costs outside your network or the establishment of new contractual relationships. Providing cost and quality transparency to providers in your ACO will help them make the best decisions for patient care.

Building care teams

You need to expand your care teams once you expand available services for more coordinated care and sometimes you need several roles that are not necessarily revenue-generating.

For example:- An administrator or care coordinator often does not produce billable hours or services that the ACO can create a claim for. However, these team members can enhance the patient experience that can have long-term impacts on patient outcomes.

Moreover, ACOs must make the challenging decision to improve care coordination by growing these non-revenue generating positions and today shared savings payments can help to support new care team members and the coordinated services they provide to patients.

This care coordination drives patients’ appointments, instills confidence in their treatment options, and builds trust with their providers. As a result, ACO will be a preferred choice for the patient rather than the emergency department.

Use data to inform decision

It is observed that still today, many healthcare organizations rely on spreadsheets and paper reports to translate data into actionable insights, but these tools are overwhelming and difficult to interpret hence many ACOs are investing in point-of-care dashboards. These dashboards provide insights on key quality metrics with the help of EHR integration.

Providers opening the EHR during an annual wellness visit can immediately see which gaps in the care they should focus on closing for patients based on the ACOs standard of care. The specific metrics highlighted in the dashboard are largely the result of the ACO agreement between payers and providers.

Moreover, the dashboard can provide quality measures that are required for payment because they are linked to payment. Moreover, ACOs can add other measures to the dashboard based on their specific patient population’s needs.

Participating in an ACO does require significant investments but these strategies are helpful to make a successful accountable care organization. If you are looking for any help in medical billing services, then you can get in touch with us.

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