By Sanjay Seth, MD, Executive Vice President, HealthEC
Twitter: @HealthEC_LLC
The COVID-19 pandemic has created great uncertainty for Accountable Care Organizations (ACOs). From the complete demise of value-based care payment models to loss of shared savings incentives, ACO concerns abound and rumors run rampant. Every day our nation’s ACO leaders are being bombarded with both superfluous perceptions and stark realities. And the pressure shows.
For example, according to an early April 2020 survey conducted by the National Association of Accountable Care (NAACOS), more than half of organizations taking financial risk in a Medicare program said they are at least somewhat likely to drop out due to nascent pressures. But is this the right decision for the right time? My personal opinion and that of many ACO executives I’ve met with is a resounding “no”.
Instead of backing away, now is the best time for ACOs to remain engaged in value. It is the time for ACOs to take power over uncertainty through smart, proactive action. CMS has announced a compensating methodology to address the financial impact of COVID on ACO’s -it needs more clarification as the statement reads : CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. Here, however, are five steps we suggest ACOs take now to improve quality outcomes today while also ensuring organizational sustainability for tomorrow.
1. Don’t Panic
The percent of high-cost ACO members due to COVID-19 hospitalization and treatment is relatively low. For most ACOs that have been performing well, your populations’ quality outcomes and costs remain in good standing. All that is needed is new tactics to manage and maintain the health of your population. Keep focused on facts versus fear for your specific populations, partners and practices.
2. Stay Focused on Your Own Population
Analyze your data, identify and prioritize highest-risk patients within your own population. Incorporate the COVID-19 criteria from the WHO and CDC into your population health platform while also including new risk factors as they emerge such as race, behavioral health conditions and SDOH.
Your COVID-19 watch list may expand over time as social distancing reduces risk for COVID-19, but increases occurrences of depression, anxiety and acute exacerbation of chronic conditions.
3. Conduct Proactive Outreach Using Telehealth
As fewer patients are seen in the ED, the opportunity for clinicians to ask questions and identify rising-risk becomes severely limited. Instead of relying on in-person visits, now is the time for ACOs to conduct more frequent, targeted and in-depth outreach to patients via telehealth. Here are four tactics to consider:
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- Use primary care MDs to conduct patient outreach now, not other practice staff.
- Conduct outreach using telehealth applications and track these visits in your population health platform. Telehealth also reduces costs for practices.
- Incorporate the patient’s at-home monitoring device data back into your systems including data from at-home blood glucose, weight and oximetry monitoring.
- Expand the questions you ask patients during virtual visits. Here are a few examples.
- Are you able to have your meds delivered? Are you ordering multi-month fills?
- What preventative or screening visits had to be cancelled? Is there a plan to reschedule them.
- Are you able to use a telehealth application. Can we conduct this visit on Facetime, Zoom, Skype or another application?
- How is your mental health? Do you have transportation and adequate food?
4. Don’t Neglect Preventative Screening
Preventative screening, treatments and therapies are critical quality metrics under shared savings. While the rules on quality reporting have not been changed yet, there is a high likelihood they will. Some payers have already made 2020 accommodations for providers.
Remain focused on quality during this time. Ask which preventative measures can be still be performed? Which steps can be taken despite social distancing and virtual visits? Now more than ever, patient conversations and virtual visits must include discussion of preventative screening measures and chronic disease management.
Some ACOs are also taking a proactive approach with payer contracting. They are asking payers to lower benchmarks and reset quality performance expectations. Meetings with CMS and Medicaid contacts are encouraged to find new opportunities for quality performance during this unprecedented time.
5. Prepare for a New Normal in Risk-Based Contracting
Someone within the ACO must keep an eye on how commercial payers, CMS and Medicaid are changing the rules of the game. There will be a new normal in managed care contracting, and it will come in waves as contracts come up for renewal or new regulations are announced. Here are three things to consider as you plan ahead for adjustments to contracts.
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- Identify your true costs associated with COVID-19 patients and any significant anomalies.
- Shift resource utilization and assignments to better accommodate virtual care.
- Review current contracts to identify which areas could change in response to new patient care patterns.
The COVID-19 pandemic creates uncertainty in healthcare. However, it also opens new doors for innovation, proactive outreach and more comprehensive care management. While your ACO focuses on COVID care today, implement these five tactics to set the stage for better performance tomorrow.
This article was originally published on HealthEC and is republished here with permission.