There are a number of essential steps every Accountable Care Organization (ACO) must take in order to create the sort of effective care coordination network that improves patient outcomes and reduces overall care costs.
First and foremost among these key steps is establishing a clear and comprehensive patient population health management picture. After all, designing the right care coordination network starts with knowing the behaviors, risks, patterns and needs of the individual patients your ACO serves.
In order to get an accurate and effective overview of your patient population health you need to ask yourself the following questions:
- Who are your patients?
- Where are your patients?
- Who is treating them?
- What are their health needs?
- Which patients are at risk for adverse and high-cost events?
- Who is sharing information?
- What are the patient care patterns within your geography?
- Is there leakage?
The answers to these questions are essential for the success of your ACO. They should help you establish a strong strategic foundation, including clinical program design, care network structure, metrics essentials, a quality reporting approach and the right payment model to operationalize your ACO.
Review last year’s data and set a benchmark. How the answers to these questions shift over time should provide an essential data set for improving your ACO’s operations.
A health IT care coordination solution utilizing a data warehouse, healthcare analytics and a reporting solution is necessary to analyze the population through the use of claims and clinical data – claims data alone is not sufficient. The analytical capabilities of that solution must include the ability to stratify patients based on one or more high-risk factors or chronic conditions, assign severity and identify opportunities and intervention points.
Every ACO is different and the recipe for success starts with making unique decisions based on a deep understanding of your patient population, as well as adopting proven best practices.