ACO Success Hinges On Provider/Patient Communication

By Greg Bengel, contributing writer

New data released from BerylHealth shows the great potential of ACOs and indicates that success is dependent on patient outreach and care coordination

Among the most popular topics in healthcare today is the idea of accountable care organizations (ACOs), created to incentivize providers to deliver quality services at lower costs. According to Kaiser Health News an ACO "would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years.”

A useful infographic published by BerylHealth summarizes the current financial state of the healthcare industry, as well as the role ACOs can play in easing some of the burden. The statistics relayed by the infographic are alarming, starting with the fact the United States spends 15 percent of its GDP on healthcare - the largest single sector of the U.S. economy. It also suggests ACOs have been predicted to save Medicare $940 million in their first four years.

But are ACOs the answer BerylHealth suggests they are? This article reveals that while some are thriving, at least one - Pioneer ACO, launched by the CMS Innovation Center - may lose nearly half its participants. That’s a disturbing development, considering the article’s explanation that Pioneer “was designed to show how particular ACO payment arrangements can best improve care and generate savings for Medicare, and to test alternative program designs to inform future rulemaking for the Medicare Shared Savings Program.”

What went wrong? According to BerylHealth, ACO success depends on a “comprehensive patient outreach and communication plan.” But their ACO Communication Plan offers a look at just how far streamlined communications between patients and providers still has to go. According to the document:

• 60 percent of referrals go unscheduled
• 25 percent of PCPs do not receive timely information after the referral
• 68 percent of specialists receive no information from the PCP prior to a patient visit  
• more than 40 percent of patients released from the emergency department don’t have a primary care physician and never follow up with a specialist

In Pioneer’s case, The Economist weighed in as follows: “ACOs are responsible for the costs of a given set of patients, but those patients can seek care treatments outside the group of providers that form the ACO. This may make it hard to contain their costs.”

The BerylHealth document suggests assessing an ACO plan on five tasks: launching member outreach, communicating network compliance, expanding patient access to care, achieving care compliance, and capturing and reporting data.