“10-to-Win” Traits in Accountable Care | Part 1

Date: 08.07.2014 | Zach Urbina">Zach Urbina

Guest blogger: CJ Fulton, ZeOmega

ACOs have forever changed healthcare’s playbook. In a few years, what it means to be a “payer” versus a “provider” will have also changed forever—but not all will make the transition successfully.

ACOs are the new retailers of healthcare and, at this stage, all are start-ups! Those who think ACOs are just “HMOs: Take Two” will likely be the ones who first succumb to history’s dooming rhyme. We live in a different time, with different rules. Technology has arrived and patients in ACO have the freedom to move out of the network, unlike those covered by an HMO in the 90s.

The paradigm requires new thinking and a new approach. I’ve identified “10-to-Win Traits” of successful accountable care organizations:

  • open component
  • new transparency
  • rewards
  • population health management
  • business innovations
  • provider engagement
  • member engagement
  • value-based contracting
  • point-of-thought decision support
  • care-team coordination.

In this article, I will focus only on the first five.

  1. Open component. ACOs are new and data will be new too.  “Open platform” design from IT vendors is not enough. Our space needs “open component technologies” so organizations can layer together and achieve greater value from the sum of the individual parts. ACO success will be dependent upon deploying the best systems in claims, EMR, PM, Rx, Lab, PACS, UM, DM, CM, etc.,—and using them harmonically is paramount.
  2. New transparency. ACOs that facilitate a greater transparency will win. Healthcare costs are going to be more visible for patients and providers to see. ED wait times, even now, illuminate bill boards. The Cleveland Clinic has already posted the price of medical instruments inside the operating room for their surgeons to see. Obviously, this is not going to do the patient much good. But, not too far in the future, healthcare organizations  will post costs for the patient to read beforehand, instead of waiting for an EOB. Extra tests can be ordered by the patient directly from the provider (“I’ll have the #3, please.”). As we all know, dollars spent can be easily converted into points in the rewards system. Pro-active care will be better served by pro-active cost awareness.
  3. Rewards. I predict the industry will see the creation of a health rewards system inside an ACO. Similar to their Marriott rewards card, patients will earn points in exchange for loyalty to control value leakage inside the ACO. Members will be rewarded for their good health, being compliant in their personal care plan and proactively improving their overall health. Patients will be able to buy gym memberships with their points or maybe even a scooter to get them there! Stakeholder access and mindshare is a critical technical component to this platform.
  4. Deploy the population health management model. This goes beyond treating only those patients in need of acute care; it likewise helps the ACO assess its entire population and stratify it into various stages across the spectrum of health.
  5. Assess and embrace business innovations. Let’s face it: healthcare has been built on silos that equate to $2.3 trillion dollar or about 20% of the GDP, the highest percentage in the world. Specialized service-oriented business models have emerged and streamline the process of taming the complexities associated with those silos. There are excellent, proven vendors that have enabled the changing role of effective healthcare management whether through SaaS, PaaS or IaaS. Savvy organizations will utilize their acute focus and leverage for the competitive advantage they enable.

Part 2 follows in two weeks…

CJ Fulton is the Director of ACO and Government Consulting for ZeOmega.  He brings over 17 years of diversified international experience in HIT,  population health design, and innovating new health care models for payers, providers and value-based care organizations.

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