A Peek into the ACO Crystal Ball

I think to some extent it will depend on how the commercial market evolves. Because some groups feel they can get their feet wet in population health management with maybe a little lower risk and less exposure if they approach it on a smaller scale with some of their commercial payers. The other thing that a lot of our groups are doing is working with employers in their regions. Those are people who tend to be interested in and be able to effect fairly broad interventions, including workplace health interventions and initiatives. I think that our groups are looking at all of those opportunities. There’s no question of long-term direction. The question is what is the best opportunity that each group has in its local market to learn how to do this using comparative data like that we’re providing and the shared learning. The model for how this team-based process works is still evolving. There are some very good best practices out there. For example, you can integrate with an employer and have a connection between the primary care that a population is receiving and a workplace health initiative. That’s a great opportunity.

What do you predict that organizations are going to be focusing this year and next to create ACOs to coordinate care?

When AMGA started its advocacy for the change from volume-based to value-based payment, they also recognized that medical groups need some help in getting and managing population health. This is a new competency for the healthcare system as a whole. A lot of medical groups are in need of help and opportunities to work with each other. One of things that has been really valuable for AMGA is the opportunity to bring people together to learn from each other. We have currently a collaborative for managing patients with multiple chronic diseases— what are the tools you need to have in place to manage these complex patients? We have an advisory steering committee for that collaborative and an interesting story came out of that first meeting when they were trying to develop the framework. And at the end of the meeting, the participants observed that no [organization there] had all of the processes in place that they had collectively defined as being necessary to care for these complex patients. That I think is a big part of what AMGA has done, bringing people together to learn from each other.

Over the past few years we have made that more data-driven by developing a collaborative data warehouse [Anceta], which is focused on the problem of managing population health and giving medical groups very detailed comparative data that they can explore for any sub group of their patients on how they are doing relative to other AMGA members and finding where there are members doing a better job and taking the opportunity to learn from them.  

We have a hypertension collaborative that was originally chartered for two years, and the groups didn’t want to stop meeting. They felt they were getting a lot out of it, so that collaborative ended up running for four years. So it’s that sort of opportunity for people to come together and learn from each other about the little nitty gritty details. One of the things someone commented on was it’s not so much that we learn exactly what the right model is from each other, is that we learn what hasn’t worked from other people and we can avoid a false start.

What care coordination tools will be instrumental this year to lay the groundwork for ACOs?

The major emphasis that I see and hear about when I talk to the folks in the medical groups is, as organizations are coming together with heterogeneous systems, it’s figuring out how to get all of that together, whether it’s an organizational-level HIE [health information exchange], or some way of doing data integration. It is clearly important, whether it needs to be at the transaction level as the HIEs would enable, or whether it can be at the data integration level, which several of the groups were working at with at Anceta. We’re getting data from different parts of their organizations. We’re actually we’re bringing the integrated picture of their own data, but also the comparative data. So that’s one, bringing things in for data integration.

Another is reaching out to patients, whether it’s through smart pill bottles, or automated scales for renal impairment and congestive heart failure, or whether it’s behavioral interventions, or a personal health record. The idea of taking advantage of a whole broad range of opportunities we have to interact with patients outside of a traditional visit or phone call is a second theme. A lot of our groups are talking explicitly about how they’re designing some of their care process around encouraging patients and how they’re using psychometric tools to measure patient engagement.