Forming an ACO? Here are some things to keep in mind

When entering into accountable care organization (ACO) agreements, providers should keep in mind the Triple Aim: improving patient care experiences, lowering per capita costs, and improving population health. The Health Care Transformation Task Force (task force) has provided guidance on factors to consider when forming an ACO agreement. The task force is made up of patients, payers, providers, and purchasers committed to changing the health care system, including through the use of ACOs established by Section 3022 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

Patient-centered care

When forming contracts, the parties must consider strategies for delivering patient-centered care. This can be achieved by acknowledging a primary care relationship with a specific provider and allowing for goal-setting and advanced care planning. Coordination of care across providers, including providing referrals for specialists and encouraging communication between providers and the patient is crucial, as is timely access to care. The task force encourages a holistic approach to health, particularly for high-need patients.

Finances

Even while providers strive to meet quality standards, ACO contracts should also reduce the total cost of care. This can be achieved by assuming greater financial risk in order to facilitate improvements in efficiency. The task force offers two models for consideration: one based on historical claims, which moves high-cost providers into cost-effective structures, and the other based on community ratings with local costs and trends. The contract should clearly divide financial responsibility between all parties. To ensure program stability, contracts should span several years and allow time for the ACO to achieve desired outcomes.

Quality of care

A key element of establishing quality of care parameters is designing the clinical model. This requires establishing whether clinical management responsibilities will be solely handled by the ACO or shared with the payer. The ACO’s leadership structure should be detailed, with roles and responsibilities clearly identified. Contracts should outline quality measures that monitor population outcomes, allow consumers to compare quality outcomes, and ensure that medically necessary services are not under-utilized. Other contract components include compliance standards, representation of stakeholders in the decision-making process, and the use of health information technology.