Hot topics from NAACOS

ACOs embracing more risk using telehealth and boosting physician engagement

By Jessica Robinson, VP of Product Management and Delivery at The Garage

The National Association of Accountable Care Organizations (NAACOS) wrapped up its Fall 2017 Conference earlier this month in Washington, D.C, with reportedly more than 650 ACO leaders in attendance.

The Garage was not only in attendance at the NAACOS conference, but we also hosted several events, including an informative and friendly breakfast. At the breakfast, our CEO, Pranam Ben, enlightened attendees on how to become a High performance ACO, which he'll write about here in a future blog post.

As in previous years, the NAACOS conference's educational sessions covered the pressing issues that these new breeds of integrated care organizations are facing, including: accepting financial risk, offering telehealth services to patients, and pursuing high-quality clinical performance through physician engagement.

Risk-bearing contracts increasing
In conjunction with the conference, NAACOS and Leavitt Partners released results from a survey of 240 ACOs of varying participant types, geographic areas and payer arrangements. What the survey found was that half of ACO respondents have at least one contract with a downside risk, either shared losses or payment capitation, a rate which has increased over the years, according to Leavitt Partners.

The survey also found that ACOs are managing these value-based care contracts through widespread health information technology (HIT) use in addition to electronic health records. For example, 84 percent of ACOs reportedly have a patient portal and 81 percent use e-prescribing. However, adoption of other technologies, such as home telemonitoring and e-visits, were only utilized by 30 percent and 45 percent of ACOs respectively. A complete population health management platform utilizing all these elements and more should be considered as more ACOs enter risk-bearing payment arrangements.

Interest in telehealth increasing
Despite the lower technology adoption levels, interest in expanding telehealth services, such as e-visits, was a popular topic among NAACOS attendees and the focus of one of the educational sessions. Currently, Medicare reimbursement for telehealth care is limited to rural areas, Chronic care management and some special provisions among select ACO tracks. However, with the bipartisan support and passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 in the U.S. Senate, those payment policies may change. The legislation relaxes reimbursement rules for Medicare Advantage plans, as well as for ACOs that face downside risk in the Medicare Shared Savings Program. In other words, ACOs just received another reason to start offering telehealth services to patients.

For an ACO to truly make telehealth services efficient and effective, it needs to be integrated with other HIT tools, such as the ACO's population health management platform, so that physicians can have seamless access to the data they need to monitor patients while automatically capturing data for future trend analysis.

Physician engagement requires support and tools
Another popular topic among NAACOS attendees at this year's conference is one that has challenged ACOs since the beginning of these arrangements: physician engagement.

Aligning physician compensation with ACO care quality and cost goals can be complex. Other than finding a fair and sustainable payment formula, physicians need HIT tools and the care team's support so they can efficiently deliver the highest-quality care. To do that, they need real-time insight to quickly and easily track and manage at-risk and high-risk patients and communicate with care teams.

When ACOs offer the physicians the tools and support to achieve their top performance, engagement becomes much more feasible, as does reaching care quality and cost goals under any type of value-based care contract.

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Jessica began working with The Garage shortly after its inception and quickly climbed the ranks to her current role of Vice President of Product Management and Delivery. In her current role, she infuses her own brand of creative thinking, innovative problem solving and entrepreneurial approach to lead a team of innovators that navigate the most complex challenges in Value based Healthcare.

jrobinson@thegaragein.com