What is an accountable care organization?
Health homes and accountable care organizations (ACOs) are formed when healthcare organizations, like behavioral health, substance use treatment and other specialty care providers, merge into integrated centers of care. These models will serve as the foundation for healthcare’s future.
- ACOs will improve quality while reducing costs.
- An increasing number of payers and providers are investing in ACOs.
- Health reform’s promotion of integrated care models will accelerate ACO adoption.
- Take away: Behavioral health provider organizations will want to create their footprint in the market as early as possible.
What does an accountable care organization do?
- Health homes and ACOs are responsible for providing the full range of healthcare services for the populations they serve. ACOs serve many Americans: Medicare and Medicaid enrollees, the commercially insured and self-insured employer groups.
- The providers comprising an ACO work together to improve their clients’ health, provide better care, and reduce costs while achieving identified outcomes. The participating providers share the savings generated by their good work.
Why is involvement in an accountable care organization important?
- Many consider ACOs as the vehicle for changing the incentives in the U.S. healthcare system so that we move from a sick-care system (the money only starts flowing after you get sick) to a true healthcare system.
How does a behavioral health provider become involved in an accountable care organization?
- Behavioral health provider organizations can now approach other health centers to do businesses together by creating an ACO that serves Medicaid, Medicare, and dual eligible enrollees in ways that bend the cost curve through successful integration — wrapping care around the most complex and costly cases.
- The behavioral health provider community has a guaranteed spot at the table. Neither health homes nor ACOs can reach the goal of accountable, affordable, holistic care without effectively including mental health and substance use providers.
- Take away: Behavioral health providers must determine what kind of relationship they want with these entities and what they need to do to qualify as partners.
What steps should behavioral health providers take?
1. Prepare for participation in the larger healthcare field.
- Identify community partners and build relationships, especially with primary care.
- Read how to create successful affiliations.
- Develop competency in team-based care and health homes in particular.
- Institute a measurement-based approach to care, incorporating standardized clinical assessment tools into routine service delivery.
- Gather data on populations served to support recognition as a “high-volume” specialty provider.
- Increase skills and knowledge in population health management, including wellness, prevention, and disease management approaches.
2. Establish credentials as a high performer relative to the triple aim.
- Adopt quality tools and train staff in using them to track performance.
- Assess clients’ experience of care, including patient-centeredness and cultural/linguistic competence, and address gaps.
- Document mental health, substance use, and general health outcomes (e.g., body mass index) and implement a plan to improve weaknesses.
- Evaluate the cost and value of the care provided.
3. Ensure information technology readiness.
- Institute information technology (IT) systems that support:
- Data exchange within and outside the organization.
- Use of data as a routine part of clinical work.
- Performance review practices.
- Management of new payment structures, including linking performance to payment.
- Reach out to community partners to form local or regional health information exchanges.
4. Plan for an extended period of change.
- Implement a change management plan.
- Identify resources and a support network for staying current on new and emerging practice and financing models.
- Invest in educating board and staff on operational and clinical changes.
What types of organizations are becoming involved in ACOs?
- Integrated health systems: Organizations like those listed above already act as accountable systems of care and are poised to benefit from this new model.
- Independent physician associations: IPAs are made up of independent provider practices that have come together to create a managed care company owned by the practices. ACOs are the next step in their evolution.
- Multispecialty groups: These are large group practices that provide primary and specialty care under a single corporate structure. The ACO model allows them to move more quickly from getting paid for volume to getting paid for value.
- Hospitals: Many hospitals are purchasing group practices in order to create ACOs.
- Health plans: Health plans are also purchasing group practices in order to create ACOs.
- Health centers and rural health clinic: As mentioned above, under the Medicare Shared Savings Program, federally qualified health centers (FQHCs) and rural health centers are now able to create their own ACOs.