Accountable Care Organizations
Patients can’t do it alone
Hospitals and health systems hold the keys to enabling patient accountability. By Miles Snowden
ealthcare industry experts generally agree patients will play a key role in driving down healthcare costs with the advent of new mod- els of accountable care, but enabling patient accountability will only be made possible with support and guidance from hospitals and health systems. While patients need to become actively involved in their own health and care, they can’t – and shouldn’t – do it alone. Putting an unrealistic emphasis on the role of the patient increases the risk they will act against the advice of providers or delay proper medical care. For patient accountability to positively impact the delivery of care, physicians, patients and hospitals must develop a shared goal of achieving the best outcomes at the lowest possible cost. Once alignment is in place, providers will then need to implement and deploy technologies to stimulate pa- tient accountability. For at-risk hospitals, the highest-cost individuals are those not currently engaged in the system and who do not consider themselves “patients.” Targeting these individuals with patient accountability strategies is critical to reducing costs for hospitals and health systems; information technology and services exist today that suc- cessfully support patients in upholding their end of the accountable care bargain.
There are three categories of “accountability enablers” that hospitals should consider as they adopt models of accountable care – demand management, population man- agement and network management. These programs and tools reduce hospital readmissions, manage chronic disease and prevent primary diseases, benefi ting both patients and provider organizations by promoting health and controlling unnecessary healthcare spending.
Demand management: Putting the brakes on expendable procedures
Hospitals and health systems often operate under the misunderstanding that in a risk-sharing environment, they will succeed by running the best clinical organization with the ability to perform the most advanced procedures. However, in addition to being reactive to patients needs,
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hospitals must implement strategies and resources to keep their at-risk population healthy, thereby reducing proce- dures. Reducing the volume of procedures performed has a direct fi nancial benefi t to hospitals and health systems when participating in ACO or other value-based contract arrangements. Two ways hospitals can use demand-man- agement tools are to lower readmission rates and to reduce unnecessary elective procedures. Reducing the readmissions of Medicare benefi ciaries yields a robust return on investment, as the Center for Medicare and Medicaid Services (CMS) penalty on high readmission rates may be eliminated or mitigated. Hospi- tals should establish or enhance existing discharge programs to focus on maintaining their relationship with Medicare beneficiaries post-discharge, either telephonically or through home visits for as long as necessary to assure there are no barriers to appropriate home and follow-up medical care. New technology categories, such as home biometric devices and telemedicine, are available for providers to effectively limit readmission risk. These care-transition programs have proven to reduce readmission rates by up to 50 percent. Demand-management technologies support clinicians in asking simple but effective questions when patients are being discharged, such as: “Where will you go post-discharge?” “Are you certain any equipment or physi- cal therapy has been arranged?” and “How can we reach you?” These interactions serve to establish a relationship that providers can continue remotely post-discharge to assure readmission risk is minimized. Discharge programs counter some of the system ineffi ciencies and better mod- erate unnecessary demand in the medical system, such as repeated trips to the emergency room.
In addition to readmissions, hospitals participating
in ACO arrangements can deploy demand-management tools to proactively reduce unnecessary medical proce- dures. Elective surgical procedures may have a large, and sometimes unnecessary, fi nancial impact on both patients and hospitals. Recent experience demonstrates that when clinicians presented patients with alternatives to elective surgery, one out of every 15 patients change to a non-
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