Another big data-driven ACO decision is the important matter of relationships with hospitals, specialists, skilled nursing facilities (SNF), and ancillary providers. Each of these ACO partnerships play a role in helping the ACO achieve the triple aim—Better Care, Better Patient Satisfaction, and Lower Cost. Your information system should be able to track which patients are seeing a specialist or other supporting provider, what the working diagnosis is, and what procedures, if any, are performed.
Hospitals may or may not be in the ACO structure. An enlightened hospital administration will understand the changing healthcare universe and work closely with the community ACO. Hospitals can supply admission, transfer, discharge (ATD) information and engage the ACO primary care physicians to help reduce readmission rates. Your data system should give you sufficient data to drive any hospital relationship in the new value-based payment paradigm, the hospital moves from a revenue center for the community to a cost center for the ACO. While it is true that hospitals do not have to be part of the leadership, these ACO partnerships are, nonetheless, important.
As ACO partnerships across the nation develop increased sophistication, community relationships with SNFs and ancillary providers are becoming increasingly important. Are your SNFs keeping patients the full extent allowable or are they meeting outcome goals earlier? Are they keeping costs in line with the community average or providing care even more efficiently? What are their readmit rates and what services or supports are they using to maintain a high standard of care, produce better outcomes, and manage cost? In the near future as ACOs move toward risk sharing, these relationships become critical. It is not sufficient to play golf together or attend the same civic club or church. Reliable data must eventually drive all relationships in the medical care community.
Do your doctors get real value from their specialists? Do you have some specialists that are high performers? How are you measuring specialist performance? Do specialists share in the savings? These are only a few of the several important questions that the leadership must consider about their ACO partnerships with specialists. Each community must decide what specialist relationships are important to producing excellent patient outcomes and financial success. Remember, for any successful relationship clear communication of your goals and objectives is key.
Home health is another potential cost driver or cost modifier. One of the most important roles of an ACO is teaching. Let the data be the center of any conversation. The ACO may need to show the providers where their ancillary cost lie. Are the doctors helping or hurting the ACO by their utilization of home health services? Do your doctors just sign any home health form that crosses their desk? Sometimes the use of data will seem repetitive, but do you remember how many times your mother told you to look both ways before crossing the street? Integrated care in this new healthcare world means working more closely with other providers in the community, building data-driven relationships, and holding others in the healthcare system accountable–just as the ACO is accountable.