By Mike Charley
The drive to transform the healthcare system from a volume based, fee-for-service structure to a value-based, “focus on outcomes” structure has been underway for several years. Escalating costs and imbalances between levels of care have jump started the movement to reform the health care payment system.
One of the first efforts in this arena has been the Accountable Care Organization (ACO) model. Pursuing this model has been a step in the right direction. Some ACOs have shown considerable progress in finding ways to deliver good health care while reducing costs. At the same time the model has demonstrated the many challenges in transforming health care.
While more than 92% of all ACO’s have been able to meet the quality metrics required to achieve shared savings, less than 30% have been able to meet the cost metrics. Lesson learned: For a fundamental change to be successful, simply tweaking current practices does not lead to success.
To achieve success as an ACO, the following principals have proven to be key:
Senscio Systems’ “Ibis” platform of care provides significant value, providing a full understanding of one’s population through integration of claims. It gathers clinical and patient generated data and has the ability to automatically identify and alert care teams of potential health exacerbations so that early interventions can preclude more serious events. Through real-time, continuous coaching of individual members, both members and physicians are empowered and motivated to take some degree of ownership member health.