As accountable care organizations (ACOs) continue to progress, they are seeking to expand population health management capabilities, including their relationships with community organizations and patients, according to new research from Charlotte, N.C.-based Premier, Inc.
The report, with support from the Robert Wood Johnson Foundation (RWJF), collected qualitative and quantitative information from 19 fully-integrated ACOs that participate in Premier’s Population Health Management Collaborative to understand the current state of ACO development and implementation, and identify barriers and potential solutions.
According to the researchers, review of the qualitative findings yielded a number of overarching themes that capture opportunities, challenges and outcomes as organizations develop and implement ACOs. For instance, while nearly every ACO studied is working with community social service organizations, 84 percent cited increased support from their community partners as an opportunity for improvement that is very different from the work that hospital-based organizations have traditionally considered. This includes moving to serve as the central hub to enable community organizations to be more effective in meeting the needs of mentally ill and chemically addicted residents, as well as teaming with employers and local gyms to offer exercise and nutrition-based counseling to address preventative health needs, the report stated.
"Increasingly, providers understand how important the things that happen outside of the doctor's office or hospital are to improving and managing a person's health,” said Andrea Ducas, program officer at RWJF. "To that end, some leading ACOs are expanding their services to include more upstream, preventive support for patients and are also expanding their work to reach entire communities, rather than just focusing on their assigned beneficiaries.”
Joe Damore, vice president of population health management at Premier, added, “What can get lost in discussions is the impact of the social determinants of health on how well ACOs perform. This analysis reveals real-world efforts underway when it comes to the importance of community partnerships to influence health outcomes and performance. We’re seeing our members collaborate with organizations like Meals on Wheels to improve the health of their populations.”
Nearly all ACOs reported using two approaches to improve population health: improving care for all high-risk patients in their attributable population; and improving care to patients with a specific disease state to target in their attributable population. Other common approaches included: helping to ensure that primary care providers use a patient-centered medical home (PCMH) model; and improving health outcomes for the entire geographic area that they serve. Less than half of survey participants use two other approaches: improving the conditions for health in their community; and helping providers become certified PCMHs.
What’s more, there are different levels of maturity among ACOs. Some are struggling with financial pressures and payer requirements related to the specific populations for which they are accountable. Only 32 percent of respondents reported that their communities had adequate resources to meet the challenge of improving community health. Limitations include, inadequate funding for staffing and services, data interoperability challenges, physicians operating under the fee-for-service model, and payer pressures.
Most of the ACOs studied are participating in the Medicare Shared Savings Program (MSSP) and a commercial ACO or shared savings program. Half of the Medicare ACOs in Premier’s Population Health Management Collaborative qualified for shared savings payments in performance year 2015. To this end, Centers for Medicare & Medicaid Services (CMS) Medicare ACO data from 2015, released in August, MSSP ACOs generated total savings of $429 million in 2015, though just 119 of the 392 organizations (30 percent) earned shared savings by holding spending far enough below their financial benchmarks and meeting quality standards. ACOs with more experience in the Medicare Shared Savings Program also tend to perform better over time, according to CMS’ results.
Researchers in this report also identified three ways ACOs are engaging to meet the ongoing and future challenges of population health and value-based payment models:
- Improving information and best practice sharing with other ACOs.
- Developing a framework for implementing population health improvement activities based on level of maturity and access to required community resources.
- Enhancing dialogue between providers, regulators and funders to set priorities for services development and future research foci.
“Alternative payment models, such as ACOs, serve to shift the traditional fee-for-service model, which incents providers to do more rather than do better, to a value-based model that aligns incentives with measurable quality, cost and population health outcomes,” said Timothy Lowe, Ph.D., director, healthcare research, Premier Research Institute, the study’s principal investigator. “As providers develop and implement alternative payment models to align with value-based payment policies, such as the new Quality Payment Program for physicians, it is critical to identify what is working and what is not to support continuous change and improvement.”
A quantitative analysis, which compares differences in patient outcomes and care costs between the 19 ACO systems and a matched sample of their non-ACO peers, will be published in a separate report, according to officials.