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Accountable Care Organizations knowledge hub

Get everything you need to know about Accountable Care Organizations, including how to determine if you’re ACO-ready.

Developing an ACO health care action plan

Create an ACO health care business plan

To begin the transition to accountable care, organizations must develop an ACO health care business plan. This should include an estimate of the initial investment required to become an Accountable Care Organization, with adequate funds for building or adapting IT and other infrastructure. It will also be necessary to closely monitor costs on an ongoing basis so the ACO and participating providers can receive incentive payments, and realize the true potential of shared savings.

Other vital aspects of an ACO action plan address collaboration, culture, technological needs and more. The list below can be considered a solid checklist to begin assessing where any organization may be in the transition to becoming an ACO.

Get physician buy-in

Physicians are at the heart of any ACO because they ultimately decide how to care for patients. An ACO needs to acknowledge the central role of physicians, involve them in governance of the ACO, and provide them with appropriate tools and support. For example, physicians need clear visibility across the patient’s care network—and the ability to influence behavior at the point of care—to achieve revenue goals and care outcomes.

Determine HIT needs

Any ACO health care action plan should consider HIT solutions that:

  • Insert quality measures into the clinical workflow where staff can act on them at the point of care
  • Align and engage providers across the spectrum of clinical, technical, cultural and financial coordination
  • Are nimble enough to quickly respond to industry change, crossing the chasm between fee-for-service and risk to drive success under any payment scenario
  • Have long-term economic sustainability
  • Appropriately engage patients in their own care

Know your patient base

By tracking how a potential patient population utilizes medical services, a health care organization can assess where patients will access care, the services they’ll require, and the frequency of utilization. Forming disease registries for chronic condition patients can help an ACO assess the status of their patients and encourage compliance to treatment plans.

Reduce leakage from your ACO

While it is unlikely that an ACO can provide everything to all its patients, reducing service “leakage” within the organization can help reduce costs. (For example, establishing or increasing after-hours care can go a long way toward reducing emergency visits.) Understanding where costs are high outside your network may reveal opportunities for new lines of business, or for establishing new contractual relationships. And sharing cost and quality information with providers in your ACO will help them make the best decisions for patient care.

Identify early opportunities for utilization reductions

When clear opportunities for savings are identified, ACOs should plan to target them. Under new contracts, certain events such as 30-day readmissions and the development of complications are increasingly uncompensated. Gaining control of and reducing these events is critical to reducing needless expenditures.

Other opportunities to reduce utilization include:

  • Reduce durable medical equipment expense by utilizing lower-cost suppliers.
  • When ACO must refer patients outside the organization, plan to utilize high-quality, lower-cost providers

Cultivate the network

A community mindset will help providers share appropriate information and develop joint responsibility for patient health. Entities such as hospitals, skilled nursing, assisted living, medical homes, hospices, practice groups and rehabilitation centers may all play a role in delivering patient care in an ACO system. Working in a coordinated and interdependent fashion is a key to deliver successful, efficient ACO healthcare.

Monitor and share performance

ACOs should regularly monitor and share performance on specific metrics and goals, including cost savings and reduction of unnecessary care, and qualitative metrics like care coordination facilitation and patient satisfaction. Sharing this information is a crucial component for motivating providers and empowering patients.

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