Do you know what your ACO Should be held accountable for?

Accountable Care Organizations (ACOs) have well defined responsibilities in their effort to achieve the triple aim: decrease costs, increase value, and increase overall patient satisfaction. One ACO responsibility is to provide appropriate data to physicians for documentation of their management of quality and cost. ACOs have specific quality metrics they must comply with, but many times the raw data is difficult for physicians to interpret.

When the data is complicated and overloaded, the message tends to get lost and the effort to improve gets put on the back burner. So the question for the administration then becomes: What is in the physician’s wheelhouse? What are some of the metrics which physicians will take ownership? How does the ACO relay this information to providers in a way that is meaningful and usable?

The next step to providing physicians with data that can be readily understood is to take apart each metric and find the derivative that can be impacted by the primary care physician. For instance, a provider can take ownership of the metric of ensuring that at least 75% of the attributed population has a flu vaccination. As another example of a derived metric, how are we trying to impact inpatient admissions. We know that primary care physicians don’t typically go to the hospital anymore because hospitalists are now in that setting. So the next step is to think about what causes inpatient admissions. Emergency room admissions typically account for the majority of inpatient admissions, and many times the emergency room admission can be part of the primary provider’s responsibility. Most office-based physicians would tell you that they don’t have control over where their patients go, especially Medicare beneficiaries who don’t have a referral network. On the other hand, ACO physicians would also know that the emergency room admission are within their clinical domain and part of their ACO metrics.

How? You may ask.

Well, if the primary care physician is truly accountable for their attributed population, then they would regularly see their beneficiaries at a higher rate per quarter in order to ensure that their patients are receiving proper care. Doctors would also consider answering their own phones during non-working hours to address any after-hour patient concerns. Additionally, the primary care practice could utilize the chronic care management process when indicated, and educate beneficiaries on the importance of calling the primary care physician first before seeking emergency care or other specialists to determine the best course of action. These proactive steps are all within the means of a primary care physician, therefore, we should be measuring them on these actions in order to impact the metric for which the ACO is held accountable.

The derivatives of the metrics ACOs use are a much better measurement of physician participation and may even engage the providers at a higher level, since they know what they can and can’t impact. So, before you give physicians report cards or progress notes, think to yourself: What’s in their wheelhouse?

Amy Kotch

About the Author

Amy Kotch, MHA

Amy Kotch is Salient’s Lead Business Consultant working with ACOs nationwide. She received a masters in health administration from Florida Atlantic University as well as a bachelors of science from the University of Miami and has just recently completed a master certification in population health through a federal grant from the Office of the National Coordinator for Health Information Technology in conjunction with the Johns Hopkins University and Normandale Community College. Her prior work includes being the operations coordinator at Triple Aim Development Group consulting with ACOs/MSOs.

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