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Healthcare

The need to control healthcare expenditure (per capita Medicare expenditure at $8973) is no longer in doubt. With over 36% of the $599 Billion Medicare spend on inpatient care, almost 19% on post acute care and over 13% on outpatient services healthcare is looking to new business architectures to contain costs as well as maintain quality. Accountable Care Organizations (ACO’s) is one such business model structured from a fee for service to a pay for performance model.

The aim of an ACO is to reduce healthcare costs, improve quality as well enhance patient experience. ACO’s are legal entities that organize around the concept of a patient centered medical home with primary care physicians forming the core who become the focal point for engaging with the patients to participate in driving superior outcomes. The ACO’s enroll healthcare participants in the care continuum who collaborate together in concert to meet the goals of the ACO.  These participants would include specialists, extended care providers (skilled nursing, hospice, extended care), physicians, nurse, dieticians and social workers. Primary Care Physicians can participate in only one ACO; the others may participate in more than one ACO.

ACOs may be fully integrated or they may draw members from outside the organization into the legal structure through agreements to complete all needed participants in the care continuum.

ACO’s have shown benefits. Cigna has done a study showing significant savings in Accountable Care Organizations. Michigan’s Value Partnership Program or Blue Shield Blue Cross MA and others have shown promising savings.

Can this shared savings be increased using collaboration, video and Telehealth technologies? There are indicators that it can:

The payout to an ACO is calculated as:

Payout to ACO= (Cost Saving) x (Shared Saving %) x (Quality Performance)

An ACO is a business architecture where caregivers need to collaborate in the delivery of care, very closely, across the care continuum. The Primary Care physician needs to remain engaged with the patient as the patient transitions through different touch-points in the care continuum. Patients remain engaged and vested in their own well-being. The physicians will practice at the top of their license leaving certain functions to appropriately trained nursing.

Healthcare IT will play a major role; one of the requirements is for at least 50% of the primary care physicians to be meaningful use users. ACOs also have to demonstrate evidence-based practice. The ACO eco system should collaborate around an EMR that could be delivered on the cloud as a service to the ecosystem.

The ACO needs to identify at-risk patients and maintain close contact. Case Managers or care coordinators will leverage technology to keep the high touch with at risk patients.

Patients also need to have access to their trending health records as well as receive focused education

An ACO can increase its cost savings through immersive video and collaborations:

Video, collaboration and Telehealth can also help in increasing the quality performance measures for ACOs:

All that is good but is there an ROI for collaborative solution video and Telehealth? Yes, our ROI models have shown that such solutions can increase shared savings as well as improve the quality metrics.

 


However, the health of the ROI will depend on  a sound network architecture and the investment in appropriate Video and Telehealth solutions:

An ACO is a collaborative organization. Healthcare services will be delivered over the network. The business architecture will implement on the IT and Network architecture; it is important to ensure that the network architecture foundation is strong and secure.

There will be big ACO successes and some not so big. Factors that will drive success are:

An ACO creates a new way to deliver care. Process will be key to ensure operational efficiencies. Mapping out the care process across the continuum for each condition, cardiac bypass or diabetes or any other condition, then creating a checklist and ensuring adherence and compliance with the process across the care continuum will help in predictable outcomes. A team of process designers to design these processes and then measure them through appropriate metrics will allow optimizing and realizing desired outcomes as well as shared savings. Success will depend on vision, strategy and execution.

 

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3 Comments.


  1. How is health reform changing nurses’ role, especially in accountable care organizations? Here is some perspective: http://www.healthcaretownhall.com/

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    • Nursing functions will focus care delivery to at risk patients at homes to reduce re-admissions, reduction in medical errors or hospital acquired infections. Nurses will play a critical role in managing quality and outcomes in ACOs.

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  2. The role nurse play and will increase to play in the medical community is significant. You can see that even in the new roles Medicare has laid out. An example of this of course is the Annual Wellness Visit that can be done completely under the care of nurses or licensed medical assistants. Interesting… Thanks for the information!

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