Building an ACO

The OIG report offers a blueprint for what it takes to be a successful ACO. It identified strategies on everything from the use of IT to engaging beneficiaries.

WORKING WITH PHYSICIANS

• Recruit doctors with a commitment to ACO goals

• Provide data on costs to inform physicians about their practices and their referral patterns

• Provide information on quality measures and gaps in care

• Redesign office workflows

• Provide administrative clinical support

ENGAGING BENEFICIARIES

• Increase wellness visits

• Educate beneficiaries on healthcare topics

MANAGING BENEFICIARIES WITH COSTLY OR COMPLEX NEEDS

• Use care coordinators to manage beneficiaries’ health

• Provide care outside of the physician’s office

REDUCING AVOIDABLE HOSPITALIZATIONS AND IMPROVING HOSPITAL CARE

• Expand access to primary-care services

• Target frequent users of emergency room services

• Improve care coordination within hospitals

• Improve care coordination at hospital discharge

WORKING WITH SNFS AND HOME HEALTH AGENCIES

• Designate certain SNFs and HHAs as preferred providers

• Embed staff in SNFs to monitor beneficiaries’ health

• Have ACO staff participate in patient handoffs to improve care transitions

• Enlist primary-care physicians to more closely assess care needs

• Use regulatory waiver allowing beneficiaries to go directly to a SNF if the hospital stay is shorter than three days

ADDRESSING BEHAVIORAL HEALTH NEEDS

• Recruit behavioral health providers

• Use data to identify beneficiaries with behavioral health needs

• Integrate physical and behavioral healthcare into primary-care settings

ADDRESSING SOCIAL DETERMINANTS

• Incorporate non-medical staff into practices to address unmet social needs

• Target resources to beneficiaries most likely to have unmet social needs

USING TECHNOLOGY TO SHARE INFORMATION

• Use one EHR system or develop alternative systems to communicate with ACO providers

• Use health information exchanges to communicate with providers outside of the ACO