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Accountable care organizations are uniquely positioned to help redesign population health, but a new approach is required.
While accountable care organizations (ACOs) are playing a key role in promoting population health, one public health official thinks these organizations haven’t reached their full potential as agents of change that can improve health outcomes for groups of patients in geographic locations.
Karen Hacker, MD, director at Allegheny County Health Department, told Medical Economics that the attention ACOs pay to high-cost patients that are chronically ill has limited the potential and scope they have to affect the health of groups of patients beyond those under their care. The Pittsburgh-based organization promotes public health by supporting individual and community wellness programs for more than 1.2 million county residents in southwestern Pennsylvania.
“ACOs tend to focus on keeping subgroups of patients – patients with diabetes, cancer, hypertension and others chronic illnesses – out of the hospital,” Hacker said. “If ACOs want to push population health further along, they’ll have to design a strategy with a geographic focus that goes beyond the patients they claim responsibility for.”
Because ACOs are comprised of a group of healthcare providers that work in an integrated care delivery system who share responsibility for the medical care, management, costs and quality outcomes of a designated group of patients, they can provide a platform from which to launch an effective population health strategy.
In 2013, Hacker wrote a policy paper for the American Journal of Public Health entitled: “Achieving Population Health in Accountable Care Organizations.” In that document, she called for ACOs to develop community partnerships to support prevention activities. While there has been progress since then, Hacker said, ACOs can and should do more.
For example, if a large population of diabetic patients lives in a geographic area where it’s difficult for them to purchase fresh fruits and vegetables at a nearby store, an ACO could partner with healthcare stakeholders to invest in a grocery store that provides that produce.
“ACOs have a strategic opportunity to partner and invest with nonprofit organizations, public health and community health organizations and other healthcare stakeholders in areas that will impact the health and wellbeing of a community,” Hacker said. “While there has been a shift in this direction, with some exceptions, the level of investment and partnerships that need to occur hasn’t happened.”
As primary care physicians think about value-based models of care and participation in an ACO, Hacker said they’ll need to consider three key areas as they seek to promote population health.
1. Understand the population the ACO is serving. If a physician is going to be held responsible for the total cost of care, then they need to understand the drivers of that care and that includes the social determinants of health and the makeup of the population (What are the needs of the people they are caring for?). Because this impacts the financial risk they are taking, physicians should be aware of the health status of the population and the various factors that contribute to that health status. To support their efforts, understanding the resources that are available outside the healthcare system, such as home visiting services, aging services, transportation, healthy food access and childcare, should help physicians support patients and keep them healthy and out of the hospital.
2. Use technology to identify high cost patients. Doctors have to know how the ACO payment structure works and find ways to reduce costs in the system. Using registries within electronic health records (EHRs) and claims data to understand which group of patients are high utilizers of care facilities is important. Equally important is collaborating with other health providers throughout an ACO to assure continuum of care by using technology such as mobile devices, mobile apps and text messages. These tools improve doctor-to-doctor as well as patient-to-doctor communications, assist patients with self-care and enable doctors to closely monitor patients' health conditions.
3. Develop strategies within the practice to better serve patients’ needs. Doctors can’t do everything, but they don’t have to either. By hiring individuals within the practice who can provide chronic care management, or striking partnerships with outside organizations where they can refer patients, physicians can elevate the care of their patients while contributing to the goals outlined by their ACO.
In a healthcare system designed to meet clinical care needs rather than public health surveillance, ACOs are in a unique positon to collect patient data and understand the epidemiology of the patient population which is imperative to keeping the population healthy.
“To elevate population health ACOs must invest more in promoting health programs in geographic locations, strike partnerships with community and public health stakeholders, and improve the capacity to assess, monitor and prioritize lifestyles, behavior, risk factors and other social determinants of health that unduly affect health outcomes,” Hacker said.