Best Practices for Designing ACO Financial Systems

At the Becker's Hospital Review Annual Meeting in Chicago on May 10, Daniel J. Marino, president and CEO of Health Directions, gave a presentation on the best practices for designing accountable care organization financial systems.

An ACO provides a mechanism for physician-led, shared governance, cost management and quality control, while ensuring physicians remain in-network. "If we are going to transform care, we need to align with these organizations," said Mr. Marino.

The healthcare system is facing a shift from a pay for service model to a pay for value model. Performance and care must be coordinated. Quality matters and providers will be held accountable. Clinical integration and ACOs have four areas of focus: quality programs and measures, payor strategy, provider membership and health information technology.

Volume measures, such as claims data, and quality outcomes, such as clinical data, both drive value and must be measured. A comprehensive approach to driving value at multiple layers, such as meaningful use, is the best strategy. When building the clinically integrated network, indentify the driving forces behind value-based performance. Connect physicians with post-acute care facilities to ensure outcomes can be gathered throughout the entire cycle of care.

ACO expenses include an initial investment, operating expenses, staffing, administrative costs and IT costs. ACOs will receive CMS shared savings, but many will wonder what the benefits to expect from this model of care. The future world of healthcare is value-based and ACOs offer the opportunity to grow in this world. ACOs will allow integration and alignment with key physicians, dynamically structured hospitals, shared savings to ensure ROI and a way to preempt physicians from aligning with

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