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4 Key Insights on Accountable Care

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Xand Griffin
September 23, 2022

The landscape for Accountable Care Organizations (ACOs) evolves to keep them moving closer to their goal of reducing healthcare costs and improving overall patient outcomes. 

In September, a few members of Healthjump’s Healthcare Organization team, Dane Rasmuson and Calli Styczynski attended NAACOS Fall 2022. Here is what they learned from the leaders and experts in accountable care just months ahead of the implementation of the ACO REACH (Realizing Equity, Access, and Community Health) model that ACOs can opt into come January 2023.

“NAACOs gave me exposure to the ACO world that you cannot find online. It provided insight into the ever-so-changing rules and what it takes to be successful in this space.” - Calli Styczynski, Business Development Representative at Healthjump

Increase Savings With Primary Care

Generally, small, low-revenue ACOs run by physicians who provide outpatient care have performed better than large, high-revenue ACOs run by hospitals that provide both inpatient and outpatient care. This trend shows that smaller, dedicated healthcare organizations that focus on primary care provide higher savings. 

“With $237 per capita in net savings, low-revenue ACOs lead high-revenue ACOs, who had $124 per capita net savings” - CMS.

Partnerships are Essential in Accountable Care 

Strong collaboration within the network helps everyone improve their care and outcomes for patients. ACOs can offer in-network benefits or financial opportunities to incentivize partnerships, but potential partners must be ready to meaningfully engage to get the full benefit of the partnership. 

Partnerships help support not only medical outcomes but social health outcomes, like healthy and safe housing and job opportunities that cannot be addressed by providers alone. 

Payment Model with a Higher Reward

Although the REACH model involves a higher level of risk, it also results in a higher reward. The Center for Medicare and Medicaid Innovation accepted 47% of applicants, noting that ACO REACH received more interest and traction than previous models.

While the risk is higher, the increased interest in the model tells us that the movement for healthcare equity and addressing social determinants of health continues to grow in the U.S.

“The Center for Medicare and Medicaid Innovation supports the development and testing of innovative health care payment and service delivery models” - CMS

Access to Data is Imperative to the Future of ACOs 

While ACOs can choose if they want to use a prospective or retrospective model for attribution, ACO REACH requires ACOs to use prospective attribution. 

“Attribution is a key program methodology used to identify the beneficiaries associated with an ACO and defines the population for which the ACO is held accountable” - NAACOS

Prospective attribution provides clarity about who the ACO is accountable for at the start of the year. However, ACOs will remain accountable for patients who they may not have a care relationship with during the performance year, like patients that move out of state or switch primary care providers. Easy access to data is essential for ACOs to better navigate this change.

How Healthjump Can Help ACOs 

Whether it is for monthly reporting, informing partnership decisions, or better understanding their patient population, data is crucial to the work and outcomes of accountable care organizations. Healthjump’s data management platform is designed for adaptability, no matter what changes your ACO faces. 

Contact our team of data experts to learn more about what we can do for you during your value-based care transition!

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