Accountable care organizations often involve high-need, high-cost patients, which can make for a very expensive and challenging program to manage. But a team of researchers has identified effective ACOs that successfully implement complex care management (CCM) interventions that insurers and providers can use to bolster their own programs, lower costs and improve care.
Targeting the high-need, high-cost consumer usually means ACOs are treating patients with multiple or complex conditions that are often combined with behavioral health problems or socioeconomic challenges, according to a brief from the Commonwealth Fund.
Some of the key common factors to the 18 successful ACO programs identified in the brief are:
1. Tailor to the local environment: Insurers should consider providers' practice size, location and governance when deciding whether to partner with them. In particular, insurers should be on the lookout for providers that deliver high quality and efficiency because providers interested in participating in ACOs should be willing to meet such measures, FierceHealthPayer previously reported.
2. Identify best patients: Identifying the most appropriate patients to participate in ACOs includes aligning populations, interventions and desired outcomes for the program.
3. Share information: Insurers and providers should freely share information to help ensure care coordination and develop strong working relationships among all ACO participants. Sharing cost and quality information between insurers and providers is one of the key benefits to ACOs.
4. Offer specialized training: ACO team members should be appropriately trained to work with high-need, high-cost patients. Training should include mentoring and shadowing experiences.
5. Incorporate technology: Insurers and providers should incorporate technology tools to assess real-time data, facilitate care coordination, monitor patients remotely and boost patient engagement.
To learn more:
- read the Commonwealth Fund brief (.pdf)