Determining your accountable care readiness

How can you determine whether an accountable care model is right for your health care organization? First, consider the following: What will your organization gain from transitioning to accountable care and taking on risk? Are community partners demonstrating a willingness to collaborate in an accountable care arrangement within your geographic area?

When you can determine your underlying reason for shifting to an accountable care organization (ACO) model, you have the core of your organization’s ACO mission statement.¹

Here are general questions to ask yourself to help determine whether your health care organization is ready to transition to accountable care:

Do we understand the true costs of care for our population?

• Do we understand the costs of care delivered inside and outside our organization?

• Do we have access to payer data across the care continuum?

Which costs can and should we try to reduce?

• Do we have the data to identify opportunities to lower costs?

• Are there opportunities for new partnerships that can lower costs of care

Do we have the ability to track quality measures?

• Do we have access to clinical data, such as information typically found in electronic health records (EHRs)?

• Do we have data that can be used to benchmark performance and drive improvement?

How will we influence providers on these measures?

• Do we have processes to standardize care and promote evidence-based medicine?

• How will we establish appropriate incentives for providers in the group?

What tools do we have to engage patients?

• Do we have patient services like a 24-hour nurse hotline, expanded urgent care and next-day appointments?

• Can we engage patients through annual wellness visits, patient portals and shared decision making?

Do we have the capabilities to share and access clinical and financial data outside the organization?

Does our organization's culture support physician alignment and leadership?

Which types of health care organizations are best-suited to take part in an accountable care setting? Hospital-based health systems and integrated delivery systems may already have many of the necessary skill sets, personnel, corporate culture and health information technology (HIT) investments to support participation in accountable care.

Smaller primary care and multi-specialty practices that already work together through mechanisms such as Independent Practice Associations (IPAs) may also be in a good position to move to an accountable care model if their organizational structure provides the ability to do all of the following:

• manage and coordinate patient care

• manage financial risk associated with the costs of patient care

• measure cost and quality in a statistically valid way²

Specialists (especially independent specialty practices) can play an important role in the accountable care continuum, and should determine how they can demonstrate value to ACOs and partner with them to lower the overall cost of care. As an example, moving specialty procedures from a hospital to an office or ambulatory surgery center (ASC) can represent startling opportunities for ACOs to reduce the cost of care.
 

<sup>1 Deschenes, S. (August 29, 2012.) 5 steps to solid infrastructure for ACO goals. Healthcare Finance News. Available at: http://www.healthcarefinancenews.com/news/5-steps-solid-infrastructure-aco-goals.

2 Miller, H.D. (September 7, 2009). How to Create Accountable Care Organizations. Center for Quality and Healthcare Reform. Available at: http://www.chqpr.org/downloads/HowtoCreateAccountableCareOrganizationsExecutiveSummary.pdf.</sup>