Accountable Care Models Offer Insights on Improving Patient Care

Treatment for chronic conditions account for most health costs in the United States. So as health care providers shift to innovative delivery models to provide value-based care while being held accountable for costs, chronic disease management plays a large role in how these models are developed. In an accountable care organization (ACO), for example, doctors share some financial responsibility and they also are accountable for the quality of care they provide.

That dual incentive means that helping patients to manage chronic diseases, like hypertension, is essential for health groups that deliver care using ACO models as they optimize care to promote population health activities.

In the latest case study analyzing ACOs, the National Pharmaceutical Council (NPC), Cornerstone Health Care, Summit Medical Group and the American Medical Group Association look at lessons learned from the implementation of the American Medical Group Foundation’s Measure Up/Pressure Down initiative. It echoes the same themes NPC has uncovered in other studies of ACO programs, including:

1. The need to have a champion in the company to promote the ideas;
2. The need for strong communication among those engaged in the processes; and
3. The ability to track or show return on investment or relevance.

In the case of the Measure Up/Pressure Down campaign as implemented by Cornerstone Health Care (CHC) and Summit Medical Group (SMG), doctors and nurses identified patients with hypertension and worked with them to get their condition under control, aiming to reach a goal of 80% hypertension control. Researchers found that the strategies employed by both SMG and CHC, such as leveraging data analysis to identify at-risk patients and comparing physician performance, as well as identifying leaders to institute change, can be replicated by an ACO or a managed care organization.

ACOs will increasingly be reimbursed for achieving clinical and financial benchmarks, which means that refining processes in order to improve quality and reduce costs is key for their success. An important factor in meeting these benchmarks is an ACO’s ability to optimize medication use. That is what happened when the Sharp Rees-Stealy Medical Group created 16 disease-specific protocols that allowed the pharmacy team to absorb approximately 80 percent of incoming refill requests for all enrolled providers. The refill clinic assessed all clinical information that a doctor would normally review in order to approve a refill. In 2014, doctors estimated that this service provided between 20 and 30 minutes of time savings per day.

Another case study describes Fairview Pharmacy Services’ successful medication therapy management (MTM) program that utilizes pharmacists’ skillsets and leverages their full clinical expertise in comprehensive patient care. While every ACO is unique, the MTM program offered lessons that can assist other organizations in improving patient outcomes while reducing costs. Specifically, the report suggested that an ACO may want to target high-risk patients, such as those who are not meeting health goals, to identify those who could benefit the most. The Fairview MTM program uses both physician referrals and data analysis to identify patients who might benefit from MTM services.

The benefits of applying health information technology to ACOs extends beyond cost and time savings. The Marshfield Clinic’s Drug Safety Alert Program, as highlighted in a case study from NPC, focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse events. Because different health care providers within an ACO may be responsible for managing the care of the same patients, Marshfield Clinic used its alert program to provide clinicians with up-to-date information to prevent drug contraindications, polypharmacy issues, and dosing errors based upon safety information received from the Food and Drug Administration and biopharmaceutical manufacturers.

Accountable care models hold great promise as the U.S. health care system shifts from volume-based to value-based payments, and as shown through these case studies, care providers are already using ACOs to provide better care more efficiently and safely.