Lessons learned from an ACO's successes, struggles

Given the Department of Health and Human Services' recent announcement that it plans to speed up its plans to shift to value-based payment models, it's more important than ever for providers to shift their priorities from volume to value. To that end, the CEO of one of the first accountable care organizations (ACOs) to form has advice for health leaders to map a way forward.

Sheila Fusé, CEO of Primary Partners, LLC, shared her insights at the 2015 OPEN MINDS Performance Management Institute event, according to an executive briefing on the Open Minds website. Primary Partners, which is composed of more than 40 independent practices and 65 provider organizations, was one of the 27 ACOs selected to participate in the first cohort of ACOs in April 2012. It operates under the advanced payment model, which is a variation of the Medicare Shared Savings Program (MSSP).

In its first year--the only one for which data is available--Primary Partners was able to achieve a 22 percent decrease in the number of emergency department visits that result in admission to the hospital, according to the briefing. However, it failed to meet some other MSSP performance measures and therefore did not benefit from any shared savings.

From the ACO's shortfalls and successes, Fusé and her colleagues have learned quite a bit. For example, they found that a key cost-saving strategy was to identify the "high-utilizer group" in its population and use social workers to coordinate care for these individuals. One recent study indicated that these super-users' complex health needs are complicated by their limited care access. However, Primary Partners is "still working on perfecting the model" of data analytics it uses to identify these high-utilizers, the briefing notes.

Indeed, electronic medical records (EMRs) are useless unless providers and ACOs can effectively leverage this information to improve health outcomes, Marc O'Connor, chief operating officer of medication therapy management firm Curant Health, wrote in a recent piece for MedCity News. He suggests organizations must develop standard operating procedures for how to use EMR information throughout the continuum of care.

Primary Partners also has found that because ACOs are not eligible for shared savings if they do not retain 70 percent of their populations, the organization's success hinges on building strong patient-provider relationships to retain its patient base. Furthermore, O'Connor advises, organizations can lower their costs by offering enhanced medication therapy management to reduce non-adherence as well as committing to tracking patient outcomes.

To learn more:
- here's the executive briefing
- read the MedCity News article

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