4 lessons from Pioneer ACOs

Accountable care organizations now total 488 and more than doubled since June 2012. With more providers looking to implement the ACO model, the Alliance for Health Reform gathered a panel of experts with on-the-ground-experience to share lessons learned.

1. Focus on data

All "Pioneer ACOs: Lessons Learned from Participants and Dropouts" panelists emphasized that good data is essential to ACO success.

"The early lesson is that data is what makes it possible," according to Elliot Fisher, director and professor of medicine, Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire. Good data systems allow hospitals to identify patients that need special attention, he noted.

Health data has been both a key to success and a major challenge for Seton Health Alliance in Austin. "One of our biggest successes has using been predictive analytics to define the high-risk patients and then get our arms around them," said Greg Sheff, executive vice president of clinical services at 11-hospital system Seton Healthcare Family in Austin.

But not only is health IT a major challenge for ACOs, data aggregation and connectivity also is key to making it all work, according to Sheff.

"Data is probably the most important thing that we try to do overtime and use it successfully to drive quality and change," echoed panelist Steve Safyer, president and CEO of Montefiore Medical Center in New York City.

2. Engage patients

"Patients that have engaged with the ACO have had very positive experiences," Sheff said. But patient engagement presents a challenge in the ACO model, largely because many patients don't even know they're in an ACO.

Moreover, people who are sick can see the benefits of less choice in an ACO model. "When you're sick you understand how complicated the system is and you're glad to have a quarterback and glad to be in a system that's going to take that responsibility," Sheff explained.

ACOs need to engage now with the other 80 percent of patients who are not in that category but will be. Those patients see their choice as more important than a hypothetical medical issue.

To enhance patient engagement, Seton Health Alliance meets with patient advisory committees and Montefiore further connects to patients by working with community organizations, such as churches, nonprofits and poverty programs.

3. Rethink emergency care

Emergency care can play a big role in helping ACOs achieve the triple aim goals of improved population health, experience of care and per-capita costs.

That's why providers must rethink how emergency rooms work, according to Safyer, who called out Mount Sinai Hospital as an example and said his hospital also is looking into moving geriatric patients to a different area as they have different needs. Last year, Mount Sinai opened New York City's first geriatric emergency room, catered exclusively to patients 65 and older.

The problem with emergency care, Safyer said, stems from the fact that ER physicians are conditioned to admitting people. "We really need to get away from that mentality," he said.

4. Expand workforce

With the ACO model comes a growing workforce. The panelists cited new positions and expanded responsibilities within their ACO programs. At Montefiore, nurse practioners are at each ER to identity patients at risk of admission and readmission, Safyer noted. The hospital also is training people to work as care managers and providing mental health guidance through psychiatrists. Nurses also are taking on more of the navigation and chronic disease work.

ACO workforces also include health coaches, who worry about the people who are going to get sick, and data managers, who try to help prepare patients and clinicians for visits, Fisher added.

While these tips could help achieve ACO success, hospital leaders must remember all healthcare is local, Sheff noted. When developing an ACO, healthcare leaders must stay focused on the reality that there are different solutions for different communities.

Sheff's Seton Health Alliance was one of the nine Pioneer ACOs to leave the program. Sheff called the move to exit the Pioneer program for the Medicare Shared Savings Program (MSSP) an administration decision, not an issue with the quality of the ACO model or Seton's commitment to it.

Reinforcing that sentiment, Safyer reminded the audience that in healthcare, one size doesn't fit all.

For more:
- here's the panel information