Why ACOs Need More From HIT

By Greer Myers, Turn-Key Health

As Accountable Care Organizations (ACOs) take on more risk under the new Medicare Shared Savings Program (MSSP), they must provide quality care while generating cost savings. This challenge is especially pronounced within the fast-growing senior population, the group most likely to experience a serious or advanced illness and who often need extensive healthcare services.

Ironically, this high-cost population represents an opportunity for ACOs to remain viable in the revised MSSP environment, and many organizations are making programmatic changes to achieve their fiscal goals and improve quality. As a result, they are now beginning to adopt innovative models that leverage palliative care:  specialized care for seriously ill members that provides relief from symptoms and stress, and offers medication management, care coordination and other support to improve quality of life for both the patient and the family.

This is precisely where specialized HIT capabilities can facilitate ACO efforts to push beyond the traditional confines of referral-based, in-hospital palliative care. While acute care palliative programs are good for many individuals, they fall short in meeting ACO broader needs to scale for larger populations, impact quality ratings or meet the goals of Population Health Management (PHM).

Conversely, specialized HIT facilitates the introduction of new palliative care models that move patients with a serious or advanced illness into the home setting — where many people prefer to be at the end-of-life. With HIT facilitating the transition to structured, community-based palliative care, ACOs can make this transformational improvement that benefits patients while improving fiscal and quality performance.

Meeting The Goals Of Population Health Management

While many ACOs want to introduce CBPC, their PHM programs are too broad and simply lack the tool set or specificity to focus on patients with a serious or advanced illness. For this reason, ACOs are turning to companies, such as Turn-Key Health, that can provide a specialized PHM-based palliative care solution that leverages technology to: 1) identify members in this consumptive population earlier in the disease trajectory; 2) facilitate consistent, effective engagement with these patients and their caregivers; 3) streamline care coordination, communication and reporting patient progress to treating physicians and the medical home and 4) achieve programmatic accountability and scalability.

Health IT can be leveraged to realize these goals, scale programs for larger populations and across broad geographic regions, and bring consistency to the delivery of palliative care. Only then can the palliative care solution truly become a meaningful component of an ACO’s PHM program and achieve positive ROI in terms of both cost and quality.

Key capabilities of a specialized palliative care solution:

Uses specialized predictive analytics to identify high-need patients who would benefit from care coordination, symptom management and establishing goals of care. This involves offering structured in-home and telephonic palliative assessments and interventions in conjunction with supporting medical resources. This approach improves care quality and outcomes, enhances member and caregiver satisfaction, and reduces costs.

Enhances a continuum of specialized services. The most effective palliative care solutions incorporate predictive analytics for member identification and to facilitate optimal engagement.

Deploys specially trained palliative care clinicians empowered by HIT to identify gaps in care, engage with patients and caregivers, anticipate caregiver breakdown and determine psychosocial issues. As a result, clinicians are better equipped to discuss advance care plans and address related caregiver burdens. Armed with smarter data and clinical knowledge at the front line, they can better identify the potential for unplanned care and non-beneficial treatment.

Leverages HIT to facilitate an approach that:

• Improves care quality and patient satisfaction
• Reduces cost and generates shared savings through reduced unnecessary hospital admissions, readmissions and ICU stays.
• Avoids over-medicalized care and high-cost services that may not align with the patient’s goals of care.

ACOs that choose to remain in the MSSP program are not wrestling with decisions over whether or not to tackle end-of-life care and quality, but how best to overcome the multitude of challenges. Ultimately, mature health IT combined with specialized palliative care strategies answer the call.