How Accountable Care Organizations Can Survive the Next Healthcare Crisis

Challenges faced by ACOs during the pandemic have been especially acute

Medical providers of all types have faced significant challenges to their finances and operations during the COVID-19 pandemic as patient volume declined and expenses for items such as personal protective equipment soared.

For accountable care organizations (ACOs), many of which take on greater risk than other providers through value-based care arrangements, the challenges have been particularly acute. In a survey of 225 ACOs near the beginning of the pandemic, 80% said they were “very concerned” about their financial performance in 2020.

ACOs did obtain some relief, however, when the U.S. Centers for Medicare and Medicaid Services (CMS) announced that its Next Generation ACO model would be extended an additional year through December 2021, and offered adjustments to payment methodologies for certain alternative payment models.

The changes are designed to give relief to providers who have faced unexpected operational challenges due to stay-at-home orders and the contamination fears that kept many patients away from healthcare clinics and emergency departments. It also signals CMS’ ongoing support of transformative healthcare models and the need to continue the transition to value-based payment arrangements that reward providers for keeping patients healthy and delivering cost-effective care.

Nonetheless, a recent report by The Commonwealth Fund offers a glimpse into the difficulties providers have been facing. Since the beginning of the pandemic, foregone visits by patients have led to what researchers have termed “cumulative deficits” in both practice revenues and patient treatment. And though they have recovered from their low point earlier in the year, according to the most recent data the number of office visits remains about 10% below what pre-pandemic levels.

The eventual effects of this delayed and missed care, particularly for patients experiencing chronic conditions such as diabetes and high blood pressure, could be severe. In fact, some healthcare leaders fear that another health crisis may be developing because patients have been skipping preventive services and screenings, such as mammographies and colonoscopies.

Consider colonoscopies, which can detect polyps that may lead to cancer. As a result of the pandemic, a patient may put off obtaining a colonoscopy by several months, then lose his job and health insurance. In this scenario, a polyp that could have been detected months ago could become cancerous and require more aggressive treatment.

It’s scenarios like this, multiplied by many patients across the country, that have physicians and leaders of provider organizations nervous that the U.S. could see a spike in preventable disease and death over the next few years. In light of this looming threat, here are three steps ACOs can begin taking today to help them survive the next health care crisis.

Leverage analytics to identify patients who may need follow-up care: Because ACOs have assumed greater financial risk related to patient outcomes than providers that have not entered into value-based contractual agreements, it is imperative that they use data and analytics to influence patient care. These tools can be leveraged to add value in several ways, including to identify gaps in care, improve care transitions, and support post-discharge programs.

However, the most advanced analytics platforms in the world are unlikely to deliver much impact to an ACO if providers don’t have easy point-of-care access to details that help them improve patient care. Leadership must ensure that the organization empowers providers with high-quality data that supports their ability to deliver the most appropriate care to patients in real time.

Implement virtual visits in tandem with in-office visits to ensure patients’ needs are addressed: While provider groups continue to manage the fallout from the pandemic, it is important that we don’t lose sight of our greater missions to improve the health of our communities. This requires a balancing act between protecting patients from the virus while also ensuring that they continue to obtain the care they need. One way to accomplish this is to promote virtual visits for patients who don’t need in-office examinations, while also ensuring those who do need lab tests, for example, still have access to in-person services.

Telehealth offers a number of benefits, including increased access to care, better continuity of care by enabling patients to visit with their existing providers, and reduced infection risk for patients and staff. Of course, the greatest challenge associated with telehealth for providers is simply that they are unable to physically examine their patients, which in some cases, limits the information they can gather about patients’ conditions. In some instances, virtual visits are not an adequate substitute for in-office visits.

Ramp up communications with patients so they understand the urgency of keeping up with their healthcare to avoid future complications: The first step to keeping patients healthy is engaging with them. That’s why ACOs should adopt broad communications strategies to inform patients about what they are doing to deliver quality care and promote safety, in addition to steps patients themselves can take to overcome their own barriers to care. Use all available channels to reach patients, including email, social media, patient portals and call centers.

Additionally, care coordinators have an essential role to play in patient outreach, as providers cannot perform this important function by themselves. For example, care coordinators should remain in close contact with chronically ill patients, proactively reaching out upon discharge from the hospital to ensure patients swiftly follow up with primary care appointments. By performing outreach and communicating with patients, care coordinators can significantly reduce unnecessary spending and improve outcomes.

While the COVID-19 pandemic rightfully remains top-of-mind for ACOs and other provider groups, it’s not too early to begin contemplating and planning for the downstream challenges the pandemic will create for the nation’s health care system. It is likely that many of these issues will stem from patients with chronic conditions who have skipped or delayed needed care. However, by taking steps today to understand and prepare for the difficulties ACOs may face tomorrow, they can help protect their communities from the next crisis.

Scott D. Hayworth is president and CEO of CareMount Medical in New York State.