By Dan White, President, Strategic Workforce Solutions, AMN Healthcare
A recent analysis of what makes an accountable care organization successful showed that most keys to success relate directly to action by healthcare professionals.
As with almost every healthcare endeavor, healthcare professionals drive the success of ACOs. A recent report about the PACT Population Health Collaborative by Premier, Inc., found that twice as many of its ACOs qualified for shared savings compared to all Medicare ACOs nationwide. The report showed that success was owed to the fact that healthcare professionals engaged patients in very different ways from traditional healthcare settings.
A recent article pointed out that Premier PACT ACOs identified their highest risk patients – the sickest of the sick -- and then set about to proactively coordinate their care and bring care to them. Traditional healthcare settings are reactive; they wait for patients to come through their doors. The most successful ACOs employ real-time care coordination with immediate communications with patients, plus home healthcare teams and telehealth to bring care to patients with complex conditions or multiple chronic illnesses.
As with all ACOs, the objectives were improved patient outcomes and reduced costs. The Premier PACT ACOs achieved higher than average scores in most of the quality metrics used to measure ACOs. The annual improvements were almost double the national rate for ACOs. They also earned a larger proportional share of the savings, which is derived from reductions in healthcare costs.
Care coordination is vital to a successful ACO, and care coordinators are the healthcare professionals who carry out that responsibility. It is a fast-growing clinical role in healthcare today, usually filled by nurses who have received special training. Comprehensive chronic disease management, to reduce hospitalizations and improve the overall health of the sickest of the sick, is carried out by care coordinators often working with home health providers and other clinicians.
Treatment of patients in their homes, senior living facilities or outpatient facilities often is carried out by advanced practice nurses and physician assistants, along with other specially trained clinicians such as health coaches. Robust use of health IT, such as electronic medical records and interoperable mobile devices, is also important to ACO success, so clinical informaticists and others in healthcare technology are important.
Healthcare professionals working in the new generation of care and payment organizations represented by ACOs must embrace a new attitude and outlook on patient care. They are proactive instead of reactive, advocating the concept that value-based care can result in better patient outcomes and costs savings at the same time. They believe in teamwork, comprehensive coordination, and communications with patients, providers and payers. And their work not only improves patient outcomes and controls costs but also results in improved patient satisfaction.
The skill sets to provide this type of patient-centered care are not specifically taught in most medical, nursing and allied health training programs. As long as ACOs remain as pilot programs, they may be able to attract enough healthcare professionals with the willingness to excel at value-based, team-based care.
However, the objective of the federal Centers for Medicare & Medicaid Services is to expand ACO-type programs so that they become the norm. Private and not-for-profit healthcare will likely follow suit. As that happens, education and training for the new and emerging roles and skills needed for successful ACOs will become paramount. Accountable care may become the future care and payment model for our national healthcare system. If so, a workforce with specific accountable care skills will be needed.