How Can Providers Establish Successful Accountable Care Organizations?

Accountable care organizations (ACOs) are a common way healthcare providers can transition from fee-for-service to value-based care delivery. In ACOs, providers come together to deliver quality coordinated care to patients while usually taking on some of the financial risk.

Providers must have the right mindset to care for patients and the capabilities to support their goals to establish a successful ACO, according to Rachit Thariani, chief administrative officer for the Ohio State University Wexner Medical Center’s post-acute and home-based care division.

Last month, the Ohio State University Wexner Medical Center and CVS Accountable Care announced the launch of a new ACO to improve care for Medicare beneficiaries in central Ohio. The CVS ACO is a Medicare Shared Savings Program (MSSP) Enhanced Track ACO that expands on Ohio State’s ACO experience. Ohio State started its own ACO in 2018, participating in a track with no downside risk involved.

“The partnership with CVS was the next logical step to provide our patients with greater care coordination and longitudinal care management that helps us address both medical and social needs,” Thariani told RevCycleIntelligence. “Working with CVS made sense because they have programs they are bringing to partners and we had certain programs, and getting together with them would help us achieve our objective in a more meaningful way.”

Part of the development process included following the technical steps required by CMS to establish an ACO. The other part consisted of the two organizations aligning their goals and understanding how they serve one another’s mission. Then, the organizations decided on the ACO track to participate—a downside risk track—and completed the technical application process.

“Of course, there’s work in the middle that talks about who provides what service, so it’s no different than any other partnership arrangement. But what was really heartening was that the core of all of this was our patients and how we can serve them in the most optimal manner,” Thariani explained.

Although Ohio State did not face any major challenges, a critical part of the ACO journey to get right was the workflow integration with their own care teams and CVS care teams.

As CMS expects all Medicare beneficiaries to be in an accountable care relationship by 2030, healthcare providers should have certain resources in place before joining or creating an ACO.

First and foremost, providers must be motivated to improve patient experiences across the care continuum. This includes having preventative services in place that can help prevent emergency department admissions, address social determinants of health, and ensure patients are taking medications as directed.

Providers’ view of patient care must encompass acute care settings, ambulatory settings, what’s happening when a patient is at home, and post-acute care.

“Organizations that want to establish successful ACOs need to have this larger mindset of how to provide care for patients throughout the continuum,” Thariani shared. “Some provider groups and systems are ready for that; for some, it represents a culture change.”

“But assuming that is in place and the provider groups understand and are embracing that change, the question becomes, ‘What are the capabilities needed to succeed in this model?’”

When forming an ACO, providers must consider their care management platforms, electronic medical records (EMRs), analytics, and data capabilities. In addition, providers intending to take on downside risk must assess the financial implications.

“At the end of the day, it’s about [delivering] high-quality care to patients, so you need to make sure you can put programs in place that help improve the quality and outcomes for patients,” Thariani noted. “You might build these capabilities or buy those capabilities or partner with somebody else to bring those capabilities to bear.”

The shift to value-based care is inevitable, given CMS’ 2030 goal, and providers should take this time to prepare for the transition.

“It’s a question of when and how—not whether—because that train has, in some sense, left the station in terms of where value-based care is headed,” Thariani indicated. “My advice is to carefully think about the journey towards value and plant the seed for that journey now because there are still opportunities to do it when you don’t have to take any downside risks.”

Joining models without downside risk would give providers time to build out, buy, or partner on capabilities and get ready for more risk in the future, Thariani concluded.