Strategies for physician-led ACOs
BOSTON—Physician-led accountable care organizations are overtaking hospital-led ones, said James Colbert, MD, instructor in medicine at Harvard Medical School and consultant for ACO Learning Network at The Brookings Institution, at the Big Data Healthcare Analytics Forum on Nov. 21.
Data from the Centers for Medicare & Medicaid Services show that physician-led ACOs are “more successful” in improving care and cutting costs. Unlike hospitals, physician-led ACOs can provide care to hospitals but also can still provide post-acute care and services so their own bottom line isn’t hurt by their success, Colbert said.
Ninety percent of physician-led ACOs are in the Medicare Shared Savings Program, and most are in commercial insurance contracts. Physician-led ACOs have between 60 and 200 primary care physician participants with attributed lives ranging from 5,000 to 13,000. Also, they have between 0-15 care managers, 0-8 data analysts (average 2) and they tend to outsource claims data analysis, he said.
Through the ACO Learning Network, Colbert works with such organizations on tools and knowledge necessary to successfully implement accountable care. He cited a number of challenges they face:
- ACOs may include different EHRs
- They lack resources to invest in complex data analytics care
- ACOs may not have access to the full spectrum of clinical data
- IT vendors over promise and under deliver
Colbert suggested several approaches to overcome these barriers,
Lesson 1: Take advantage of data already available. This includes looking at data to analyze patients who have been admitted to the hospital two or more times during the past six months; patients with three or more chronic conditions; and patients on high-risk medications like anticoagulants or immunosuppressant insulin.
Lesson 2: Start by defining your interests. In other words, define what will happen once patients are identified. This could include complex care management, home-based care, telephonic patient outreach and a disease-specific intervention. For example, for $250,000, an ACO can invest in a complex care management program with three care managers (costing $80,000 for salary and benefits) who could each be assigned 100 high-risk patients. So from there an organization would need to choose 300 high-risk patients for enrollment.
Lesson 3: Sort patients into actionable buckets. Put the population into groups based on their conditions, like congestive heart failure, diabetes, stage IV cancer and high users.
Lesson 4: Combine raw analytics with provider intuition: Look beyond the algorithms and take into account patients’ other information as known by providers: their living situation, social network and ability to achieve health goals. Physicians “identify different patients than commonly used algorithms,” he said.
Lesson 5: Use patient-collected data. Patient engagement and activation are correlated with health outcomes and cost, he said.