Accountable Care Organizations Improve Quality, Cut Spending
As payers and providers collaborate more closely through accountable care organizations, they are achieving measurable financial results.
- Accountable care organizations (ACO) are beginning to achieve results as they help to move the healthcare system towards a value-based care delivery environment. As the popularity of these arrangements continues to grow, the changing dynamics between payers and providers are improving quality, boosting communication, and cutting costs.
According to a recent analysis by The American Journal of Managed Care, the maturing ACO ecosystem has led more providers to leverage data analytics for care improvements even as they accept more downside financial risk.
The survey of 36 health plans revealed that payers believe providers have become more receptive to financial changes since 2011. Smaller provider groups are participating in ACOs, and healthcare organizations are accepting more technical assistance as part of their accountable care contracting.
Before the implementation of the Accountable Care Act, data sharing and collaboration between providers and insurers was not as common. Even as recently as 2014, insurers typically failed to consider clinical information provided by doctors and failed to inform patients of their appeal rights when they were making decisions.
Now that accountable care organizations are helping providers and payers share the same goal of delivering high-quality, cost-effective healthcare, the industry as a whole is relying more on the ability to share information to ensure actionable and informed decision-making.
"We found that utilization reports, inpatient census reports, and clinical quality rates were the most common types of data shared with ACO providers," the authors reported. "Data on care gaps, financial targets, and patient experience also were being shared by a majority of the plans surveyed," they added.
This data is helping providers engage in population health management and care coordination programs, the survey said.
"Within the past several years, greater integration of clinical and electronic record data, as well as medical and pharmacy claims, has allowed plans to identify at-risk members earlier and generate a more comprehensive view of a patient's health," the authors said. "Beyond acquiring the data, there appears to be interest among some ACOs to use these data and analysis to identify appropriate referral partners," the authors added.
According to the report, 64 percent of health plans managed financial risk, and half of all health plan contracts included shared risk as part of their reimbursement structure. Many health plans also reported using a mix of reimbursement methods in ACO contracts, the survey said.
Researchers believe that changes in reimbursement methods, provider eligibility and a new emphasis on technical assistance have caused healthcare quality to improve since 2011.
Readmission rates were down slightly. Insurers reported that emergency department visits dropped between 19 and 50 percent. Prescribing lower-cost medications rose between 21 to 52 percent, the report said.
Various organizations also continue to see improvements in the healthcare industry as health plans and providers in ACO partnerships work together more.
“Today’s healthcare marketplace features increasing consumer choice, more transparency of cost and quality information about health insurance products and health care services, closer alignment between health care systems/hospitals, physicians and providers along the continuum, and greatly improved information technology as compared with earlier decades.” American Hospital Association said.
Although ACOs continue to mature, they still encounter challenges as they transition to alternative payment models. It was difficult for ACOs to align quality measurement and reporting, researchers said. They also had a difficult time including smaller practices in alternative payment models. Lastly, ACOs struggled to develop tools and materials to assist consumers in learning more about the benefits of value-based care.
As ACOs transform and relationships between health plans and providers change, more growth pains and success stories are likely to arise. At the end of the day, it can be argued that data sharing, managing financial risk and collaboration can lead to a more effective healthcare system.
