2 ACOs Share Successful Strategies

About 18 percent of hospital executives report having an accountable care organization in place, and that is expected to double by the end of 2014, according to Premier's 2013 Fall Economic Outlook.


While more hospitals get involved in the new care delivery model and population health management, certain trends are emerging in ACO composition and how they improve the health of their populations.

Leaders from two ACOs joined a press call Dec. 18, hosted by Premier, to discuss what their organization is doing to achieve the triple aim goal of accountable care.

Health IT

Hospitals cannot successfully manage the health of a population, in an ACO or in general, without health IT systems. "Robust IT is critical to success" in population health management, Stephen A. Morgan, MD, senior vice president and chief medical information for Roanoke, Va.-based Carilion Clinic, said during the press call. Carilion Clinic is a Medicare Shared Savings Program participant.

The system spent years integrating each of its care settings on a unified electronic medical record system and database, but, according to Dr. Morgan, the system "quickly realized an EMR would not provide all the data we would need." So now, Carilion Clinic mixes claims and clinical data to "provide a more robust picture" of what patients are doing inside and outside the system. And the eight-hospital system is not alone: 72.5 percent of Premier's survey respondents integrate clinical and claims data to better manage population health.

According to the Premier survey, many hospitals are taking health IT a step further. Half of respondents said they use predictive analytics to forecast patient and population needs — something Dr. Morgan said is also happening at Carilion Clinic.

Commercial ACO value drivers

Richard Klein, the executive vice president of enterprise business group at Aurora Health Care in Milwaukee, Wis., also joined the press call. Aurora Health Care has a commercial ACO agreement with Aetna and Anthem Blue Cross Blue Shield, and more than 60 employers have signed on since it launched.

Mr. Klein cited the following 10 items as value drivers in the system's ACO:

1. Nurse navigation for chronic disease management
2. Preventive screenings
3. Onsite education specific to employers
4. Connection between care coordination and plan design
5. Minimal repeat or duplicate tests through a single EMR and care management
6. Medical management of episodes with the insurance carrier
7. Nurse navigation on the employer worksite
8. Frequent ED patients
9. A focus on wellness focus in health design and at the worksite
10. Direct communication between ACO providers and the employer

Mr. Klein said Aurora sees engagement on employers' worksites as an opportunity to drive increased value through improved engagement with

"We view this as a superior model not just for taking on risk, but for delivering care," Mr. Klein said of the ACO model.

Looking ahead

Joe Damore, vice president of population health management for Premier, joined the call and shared some predictions for the future of ACOs.

"We are seeing…an increase in interest on behalf of midsize and large hospitals," he said. Indeed, 30.2 percent of mid-sized hospital leaders and 35.9 percent of large hospital leaders said they plan to participate in an ACO by the end of 2014, according to Premier's Fall 2013 Economic Outlook survey.

Mr. Damore also noted payers' increased interest in population health arrangements.

Additionally, he expects to see increased formation of multi-owner regional ACOs, where different hospitals in a region come together to focus on population health management. "I see that trend in many states right now."

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