Accountable Care Trends, Strategies, And Best Practices

Justin T. Barnes, former VP of Greenway Medical Technologies, Co-Chairman of the national Accountable Care Community of Practice, and Chairman Emeritus of the HIMSS EHR Association

This article provides advice on how private practices can merge health IT with payers, patient engagement, and liquid data to form accountable care organizations (ACOs).

Movement within the nation's healthcare system has been swift and broad-based in the months between the Centers for Medicare and Medicaid Services (CMS) Medicare Shared Savings proposal in March and the issuance of the Final Rule in October. As a provider or the leader of a provider organization, the challenges are technological, financial, legal, and simply finding a seat at the table. As consensus grows that care coordination is key to healthcare sustainability and improved care, best practices are emerging toward making operational communities of care a reality.

The reality for healthcare providers is the time has come to examine the models being proposed or already forming in your area that could impact your future. It is becoming essential to engage peers in discussions of their knowledge and strategies as well as attend informational sessions by payer or insurance groups, employers, hospitals, or even regional CMS offices.

What quickly emerged strategically is that while the Shared Savings plans target America's nearly 50 million Medicare patients, private payers such as UnitedHealthcare, Aetna, Cigna, Blue Cross/Blue Shield and others — mindful of the savings accountable care can bring to their operations along with the promise of better care — are seeking entry into or are forming accountable care models by approaching hospitals and physician groups. Doing so is accomplishing the greater goal of bringing more patients into the process, and healthcare providers are welcoming multiple payer options.

These resulting best practices are aligning around the core elements of comprehensive health information technology, the alignment of multiple payer options, patient-centric engagement and retention strategies to assure that patients comply with preventive care plans, and the ability to mine existing claims and care data that offer providers a clear pathway to their own clinical best practices. And the possibilities of what Accountable Care Organizations (ACOs) and coordinated care can accomplish are bringing other factors and strategies forward that could emerge within the CMS Shared Savings model, or as commercial ACOs outside the purview of CMS and the federal government: Access This Content To Read This Article In Its Entirety.