As value-based healthcare continues to evolve, an increasingly viable delivery option is the accountable care organization (ACO). In this model, a group of healthcare providers voluntarily join together in delivering care to defined patient populations – typically sharing responsibility for the quality and cost of care and operating under a variety of risk-bearing arrangements.
With each year, the accountable care movement grows exponentially. At the start of 2016, more than 800 ACOs were active throughout the US – across public and private health insurance programs – and another 1,000 partnerships were negotiating ACO contracts. Today, an estimated 28.3 million people are covered under ACOs; analysts predict that number will increase to 70 million by 2020 and 150 million by 2025.
Reporting quality metrics
A hallmark of ACO success? Proven and measurable quality of care. Measurements for gauging quality are rigorous. For example, participants in Medicare’s ACO program need to meet 33 quality measures to share in savings. Metrics span care coordination and patient safety, the patient experience, preventive care strategies, and at-risk population health management.
“For many providers, collecting patient data to satisfy these metrics can be challenging,” says Robin Hill, RN, vice president of clinical solutions at Vivify, a fast-growing international digital health company. “ACOs are looking for seamless solutions that can capture the required information for reporting compliance.” A key tool for data gathering is remote care monitoring solutions using BYOD, or bring your own device, she notes. “As patients engage with their care teams, they answer questions on their smartphones or tablets that can meet many of the quality measures – efficiently and economically.”
Reining in costs
ACOs are focused not only on improving quality, but on reducing costs. The more they keep patients out of the hospital, the more they’re paid. According to Hill, BYOD remote monitoring solutions can help ACOs create more cost-efficient workflows through “managing by exception.” “The software becomes the triage nurse, sorting interventions based on level of need,” she explains. “ACOs can then proactively manage changes in health status before a patient ends up in the hospital or emergency room, averting associated costs and readmission penalties.” Savings are realized, too, by employing the lowest-cost monitoring tool on the market: the patient’s own mobile device and data plan.
Reducing risk for populations
With the BYOD solution, ACOs can be more effective in population health management. “For patients who are at risk or rising risk, it offers a pathway for providing more education, influencing behavior, and creating better outcomes for patient populations,” Hill says. “Care teams can understand what’s going on with each patient daily or weekly, as opposed to once or twice a year through an office visit. With a continuous and more complete picture of patient health, they can adjust care plans as needed and proactively engage populations in managing their own care.”
Reaching the masses
With BYOD, ACOs have a ready method for extending evidence-based care without adding more clinicians. “It’s all about leveraging technology, not resources, to connect with and empower a larger percentage of their populations,” Hill says. “Rather than clinicians reaching out telephonically to each patient, the technology becomes the virtual clinician, collecting patient data on the spot and feeding it back to the clinical team, who in turn can manage, measure, and act on this information.” The ACO can then use data analytics to predict risk for chronically ill patients, develop prevention strategies, and determine how well populations are being managed.
Realizing additional revenue
The BYOD solution can also help ACOs track patients under the chronic care reimbursement code, CPT 99490, from the Centers for Medicare & Medicaid Services (CMS). The CMS program pays $42.60 per month for 20 minutes of non-face-to-face care coordination services provided to Medicare beneficiaries with two or more chronic conditions that are expected to last at least a year. “Through BYOD, each second of care is tracked, and a report is generated that confirms government requirements were met,” Hill explains. “Fully realized, this reimbursement can help healthcare providers accrue tens of thousands of dollars in additional revenue.”
Reshaping the future of care
Through BYOD remote care management and digital coaching, ACOs can deliver the most effective user experience at the most economical cost, Hill notes. Patients have a personalized tool for taking a more active role in their health, improving self-management skills, and pursuing healthier lifestyles. As a result, this technology advances the goals of population health management by focusing not only on chronic care management but also on the continuum of health and preventive care. “As ACOs strive to meet the needs of defined populations, the BYOD remote care solution can be a best practice for transformation – improving health outcomes, lowering costs, and making care truly accountable.”