ACO Coalitions Key to Population Wellness

The number of articles, whitepapers and reports being generated about accountable care organizations is increasing exponentially, with the vast majority covering the nuts and bolts of creating an ACO and exploring various payment strategies. These are all important issues to address. At their core, however, ACOs are about making the population healthier so the costs associated with providing primary, chronic and acute care can stabilize, and in an ideal situation, decline over time.

What is all but absent from this discourse is how ACOs are going to improve the public's health. We believe ACOs will catalyze a new era of public health. Fundamentally, this model will work only if the health status of covered lives improves over time. And, unlike managed care, federal law, Medicare and Medicaid payments will reward successful ACOs.

Population health is rarely discussed in ACO literature because hospitals and physician practices don't yet know how to approach the issue. They don't know how to measure population health and risk factor status, and many don't know how to mount community-based wellness programs. This is why ACO organizers need to reach out to the public health community and build market-wide coalitions that include local health departments, community health clinics, United Ways, dental clinics, non-profit organizations focused on the health of children and seniors, and other community health organizations.

Local health departments are typically skilled in generating and collecting existing health status measures and translating them into valuable baseline reports and targeted wellness programs. They use the vast programming resources of the National Association of County and City Health Officials so they can apply and adapt proven wellness solutions.  

Health departments can provide numerous resources to achieve core ACO requirements. In part, these include:

  • Community coalition building — Organizing and sustaining coalitions are critical to planning and conducting successful large programs across multiple community sectors.
  • Community health assessment — Documenting measures of health and associated risk factors are essential to assessing community health status. Many local health departments have been doing these for years, and ACOs are required by the IRS to conduct them every three years.
  • Health improvement planning— Data from community health assessments will help ACOs and community leaders prioritize health issues and understand community needs. In turn, they can use this information to design, implement and evaluate successful programs.
  • Community health initiatives — It is only through multi-site, integrated efforts that wide-scale health initiatives can succeed initially and over time. Local health departments know how to do this.
  • Training — Through training with public health professionals, ACO leaders can learn and be mentored and supported as they adapt to this new healthcare environment.

While health departments may not be part of the provider pay model, they can be the best allies for ACOs as they work to improve community health status. Here is how this can work:

1. Assess community health. ACOs can fund health departments to take the lead on conducting community health assessments. With the right tools and approaches, they can map the residences of patients based on diagnoses, utilization of resources and severity of illness — all of which ACOs and health departments can use to understand the where, why, when and hows of community need, disease prevention and health promotion programming. This evaluation can focus on individual patients, physician practices, neighborhoods, municipalities and entire counties.

2. Develop programs.
ACOs can fund health department to develop and or adapt health promotion and disease prevention programs for their communities. They can also work together to implement these programs, link them to ACO physician practices and get them up and running in other locations where they are needed most.

3. Expand programs. ACOs can fund successful LHD programs to improve community health status – e.g., obesity prevention and treatment, immunization, and nutrition programs — by bringing them to new populations and communities. ACOs can also implement these programs at their physician practices and urgent care clinics, and can recommend neighborhoods where they would do the most good.

4. Pilot-test programs. ACOs can fund the testing of new and or adapted programs with health departments. This will increase the odds of solving program shortfalls, build community buy-in and provide critical information about high-need community populations.

5. Evaluate programs. Hospitals and physicians can share the clinical outcome data of patients who participate in health promotion/disease prevention programs and receive care at their physician practices, hospitals, emergency departments and urgent care facilities. Once analyzed, this information will be especially beneficial to adapting programs to achieve even greater success.

6. Invest in programming support. ACOs can also purchase technical support and consulting services from experts, who specialize in designing, customizing and evaluating public health programs, to work more effectively with health departments. ACO staff can also be trained to conduct these programs so they generate consistent and high-quality results.

7. Market. Unlike local health departments, ACO hospitals know how to design, place and purchase advertising that can successfully promote community-wide initiatives for priority health issues.

Together, LHDs and ACOs can share their skills to achieve better program and health outcome results. They can coordinate programs to reach larger populations and reinforce the messages and skills they each teach. They can also strengthen each other's operations — imagine a hospital finance person teaching her local health department to conduct more nuanced financial analyses. Imagine hospitals learning new insights for communicating with poor and uninsured patients. Even more exciting, imagine hospital systems and health department jointly developing and operating clinics in underserved areas at low cost.

All of these activities — from coalition building to delivery of market-wide wellness programs — can be funded in part through philanthropy. Local businesses, foundations and philanthropists can be recognized for their support of community wellness knowing that their philanthropic investments are going beyond the walls of their local hospital to embrace the promise of a healthier community.

Larry G. Raff, MPH, is president and principal of Copley Raff, Inc., a leading philanthropy consulting firm based near Boston. He brings three decades of leadership and experience to healthcare organizations seeking advancement results. His clients include four of New England's largest multi-hospital systems, the largest multi-hospital system in the Midwest, numerous academic medical centers and community health centers. He also provides counsel to national scope organizations including the American Optometric Association, National Consumer Law Center, National Association of County and City Health Officials and the Massachusetts Medical Society.

More Articles on ACOs:

3 ACO Readiness Strategies
19 Questions to Ask on the Road to Accountable Care
ACO Patient Population Attribution: Prospective vs Performance Year Methods

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