Accountable Care Organizations: The Missing Link to Engagement in Health and Health Care?

Accountable care organizations (ACOs) aim to transform health care delivery and provider payment in a way that improves patient access, engagement and quality of care. If successful, ACOs may help the U.S. health care system finally evolve from a "diagnose, treat and reimburse mostly acute, episodic health care" approach to one that encourages and compensates health care providers that work with their patients throughout a full continuum of care to prevent and manage chronic conditions. What are the implications for ACOs from a workforce health perspective? ACOs were built on a framework for delivering evidence-based health care interventions to engage patients in managing and improving their health. But to what extent do ACOs or employers actually follow such a framework and how can these interventions be integrated with workplace health improvement and wellness efforts? The authors explore the mechanisms for impacting workforce health and provide a checklist to assist employers with evaluating ACOs and assessing feasibility of potential ACO integration with workplace health improvement programs.

Changes in patients' experiences in Medicare Accountable Care Organizations

BACKGROUND

Incentives for accountable care organizations (ACOs) to limit health care use and improve quality may enhance or hurt patients' experiences with care.

METHODS

Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data covering 3 years before and 1 year after the start of Medicare ACO contracts in 2012 as well as linked Medicare claims, we compared patients' experiences in a group of 32,334 fee-for-service beneficiaries attributed to ACOs (ACO group) with those in a group of 251,593 beneficiaries attributed to other providers (control group), before and after the start of ACO contracts. We used linear regression and a difference-in-differences analysis to estimate changes in patients' experiences in the ACO group that differed from concurrent changes in the control group, with adjustment for the sociodemographic and clinical characteristics of the patients.

RESULTS

After ACO contracts began, patients' reports of timely access to care and their primary physicians' being informed about specialty care differentially improved in the ACO group, as compared with the control group (P=0.01 and P=0.006, respectively), whereas patients' ratings of physicians, interactions with physicians, and overall care did not differentially change. Among patients with multiple chronic conditions and high predicted Medicare spending, overall ratings of care differentially improved in the ACO group as compared with the control group (P=0.02). Differential improvements in timely access to care and overall ratings were equivalent to moving from average performance among ACOs to the 86th to 98th percentile (timely access to care) and to the 82nd to 96th percentile (overall ratings) and were robust to adjustment for group differences in trends during the preintervention period.

CONCLUSIONS

In the first year, ACO contracts were associated with meaningful improvements in some measures of patients' experience and with unchanged performance in others. (Funded by the National Institute on Aging and others.).

Report of the 2013 AMCP Partnership Forum on electronic solutions to medication reconciliation and improving transitions of care

BACKGROUND

The Affordable Care Act (ACA) is driving the evolution of reimbursement from a fee-for-service model to an outcomes-based system. Accountable care organizations (ACOs) are 1 component of this evolution, and 1 of their charges is to reduce hospital readmission rates for key diagnoses such as congestive heart failure (CHF) and other cardiovascular comorbidities. Lack of patient follow-up and adherence are 2 major causes of readmission. Providing strong medication management is 1 of the common factors in successful readmission programs. We discuss here how electronic solutions might strengthen these medication management programs.

OBJECTIVE

To explore the key issues and strategies that affect the use of electronic medication reconciliation processes and to identify the role the Academy of Managed Care Pharmacy (AMCP) can play in spearheading the adoption of electronic solutions.

METHODS

This was a descriptive analysis of the medication reconciliation process and the factors that promote or limit the application of electronic solutions to medication reconciliation and transitions of care processes. AMCP convened a panel of managed care, hospital, community, ACO, and medication therapy management pharmacists; technology vendors; and other health care stakeholders with an expertise or interest in transitions of care.

RESULTS

In the last few years, there has been considerable uptake of electronic solutions to the admission medication reconciliation process, largely due to increasing penetration of vendors using sophisticated medication history tools. The current electronic solutions to the admission medication reconciliation record are remarkably similar in content. Some pilots for electronic solutions to discharge medication reconciliation are emerging.

CONCLUSIONS

The focus group recommended specific programs AMCP can pursue to increase the adoption of electronic solutions for medication reconciliation. One important aspect to address is developing a business case that documents the return on investment (ROI) for electronic solutions. Besides electronic efficiencies, the ROI needs to include hospital readmission penalties, loss of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) incentives, avoidance of duplicative efforts, and payer costs for readmissions. Managed care pharmacy needs to be engaged in assessing its incentives for promoting electronic solutions.