The transition to ACOs and population health: 5 key thoughts

Healthcare systems are increasingly entering into accountable care organization agreements and embracing population health management because, at their cores, they are good for patients. Each strategy aims to improve healthcare delivery through enhanced coordination of care and keeping people healthy and out of the hospital. However, both ACOs and population health efforts are riddled with challenges.

At Becker's Hospital Review's 6th Annual Meeting in Chicago, Gyasi C. Chisley, CEO of Methodist North Hospital and senior vice president of Methodist LeBonheur Healthcare in Memphis, Tenn., and David DiLoreto, MD, clinical operations and innovation officer at Chicago-based Presence Health, discussed the important aspects of ACOs and population health management, the challenges associated with successfully implementing them and strategies for the future.

1. "Population health is the guts of the ACO," said Mr. Chisley. The Methodist system, which is in its infancy in its ACO development, is following what Mr. Chisley calls the five key "P" ingredients involved in population health management as they relate to ACOs.

The first is physicians. A clinical integration strategy has to serve as the cornerstone of migration to ACOs. Second is payers, as they are taking on more risk in ACOs than ever before. The third P is patients, because they must pick up some of the risk too. Next is partnerships. According to Mr. Chisley, good population health strategies in ACOs are predicated on partnerships. "Health systems can't do it all by themselves," he said. The final P is policy, because policy is a strong determinant in how quickly ACOs can accelerate into the risk world.

2. "This is not an easy business," Dr. DiLoreto said of running an ACO. He described Presence Health's ACO as a "pretty fast ride." Presence created its ACO in 2013 with 40,000 covered lives, and today includes approximately 250,000.

"Health system strategy is quickly moving toward population health management because of the market-facing opportunities it presents," Dr. DiLoreto said. "However, there are a lot of challenges to grow in the ACO space."

The complexity of building and running an ACO has pressured many of the pioneer ACOs out of the federal programs. However, for systems in the preliminary steps of their own ACOs, they do not have to reinvent the wheel. According to Dr. DiLoreto, new ACO entrants can benefit from looking to systems that have been successful with their own ACOs. One of the primary elements they will notice of successful ACOs is their culture of accountability. As a population health manager, you have to align rewards inside your hospital your goals, he added.

3. "Culture transformation is the biggest obstacle," said Mr. Chisley. As systems migrate toward population health, they need to make sure they can sustain it. Ultimately, this will always come down to quality, so a health system's culture must reflect that. Implementing specific performance indicators and establishing a care continuum will help uphold a culture that holds its clinical and other staff accountable for quality.

Another critical component of success in ACOs and buy-in from patients in population health is the patient experience.

"We are transitioning from satisfaction to experience to ensure a positive patient experience even from before a patient comes through our doors to the acute to the post-acute side," said Mr. Chisley.

4. Case managers are playing increasingly important roles. Case managers are critical for sustaining population health efforts today, and will continue to be in the future. Case managers are part of multidisciplinary teams in ACOs and patient-centered medical homes and serve to better integrate care for targeted populations. Usually, the sickest or highest-risk patients will be assigned a case manager that helps them understand the medical care they receive and take steps to stay out of the hospital.

"In the 1980s and 1990s, case management was where nurses went to end their careers," said Mr. Chisley. "They could end their day at 5:00 and go home. Now more than ever do we need all hands on deck. Physicians, social workers, nurses and case managers are all needed to make sure the care continuum is addressed."

Historically, case management has operated in silos, according to Dr. DiLoreto. However, now case managers are creating a bigger presence in communities as they work within population health efforts. They regularly work with community leaders and local, non-medical organizations to give their patients the best support possible, and of course communicate regularly with their patients' medical care teams.

5. ACOs are fueled by the power of potential. According to Dr. DiLoreto, while healthcare strategy today needs to be proactive, it also needs to have the flexibility to be reactive to meet immediate needs and demands.

"This is what's exciting about healthcare," said Dr. DiLoreto. "There is heroic activity and greatness that goes on every day in our facility. In ACOs there is great data. We have claims files going through analytics, our case managers are proactively reaching out to manage the population and we are orienting our organization around new ways of delivering care. I'm optimistic that our greatness is being extended in a new way."

More articles on ACOs:
5 Dallas health systems combine ACO efforts
3 key elements of business development in a risk-sharing landscape
6 challenges hospitals face in ACO adoption

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