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With the continuing shift from traditional fee-for-service to value-based healthcare models, Accountable Care Organizations (ACOs) provide an excellent steppingstone for practices and physicians who want to integrate value-based care into their organizations.

At its core, an ACO is a group of healthcare providers who work together in a coordinated fashion to enhance the overall health outcomes for a defined patient population. One key objective of the ACO model is to achieve better coordination and communication among healthcare professionals, ensuring that patients receive the right care at the right time while avoiding unnecessary duplication of services and increased costs.

How ACOs work

ACOs use a collaborative and data-driven approach to achieve their goals. Healthcare providers within an ACO share information, adopt common clinical protocols, and leverage technology to streamline communication. The use of electronic health records (EHRs) plays a crucial role in facilitating the exchange of patient information and ensuring that all members of the care team are well-informed.

Reasons to join an ACO

While new care delivery models may seem intimidating, organizations waiting to make the transition to value-based care are missing out on several significant benefits that can have major long-term positive impacts for their practices and their patients.
Here are a few key benefits of participating in an ACO.

  1. Increase revenue and reduce healthcare costs
    The goal of an ACO is to ensure patients, especially those with chronic conditions, receive the appropriate care, in a timely fashion, utilizing appropriate resources. To promote this model, financial rewards and incentives are often conferred to providers who achieve measurable results in areas such as reducing hospitalizations, improving clinical outcomes, and minimizing the use of unnecessary tests and services. When patient populations stay healthier and providers find ways to reduce costs, the ACO and providers generate shared savings, contributing to additional income. ACOs can also financially incentivize physicians who improve their practice workflows or participate in engagement activities like meetings or events.
  2. Improve patient outcomes
    The Centers for Medicare & Medicaid Services (CMS) outlines several quality care measures focused on prevention (like cancer screenings and wellness visits) and managing chronic conditions (like diabetes, CKD, hypertension). These measures often result in better patient care because conditions are identified early, treated in accordance with evidence-based guidelines, and subsequently monitored, resulting in improved clinical outcomes and reduced wasteful spending. The measures also financially incentivize providers who keep their patients healthy and well, instead of rewarding providers for volume of patients seen, the number of tests they order, or quantity of services provided.
  3. Stay in control
    Several ACOs are physician-led, ensuring doctors feel empowered to advocate on their patient’s behalf, and providing those doctors with a valued voice when it comes to implementing change and incorporating feedback within the ACO model overall. Many ACOs, like Vytalize Health’s, also ensure physicians remain independent and in charge of their own practices.
  4. Access to resources and services
    ACOs take advantage of technology and implement solutions, oftentimes at no cost or minimal cost to providers and practices. These resources include actionable data in a single platform that helps providers identify the services each patient needs. Many ACOs also offer programs and services tailored to supporting the highest-risk and sickest patients that would be difficult for smaller practices or solo practitioners to operationalize on their own.
  5. Coordinate care better
    The ACO model also encourages families and caretakers to be active partners in patient care, which also results in better patient outcomes. Patients can avoid costly hospital stays and procedures when all parties involved stay informed. For example, coordinated care within the Vytalize ACO specifically has led to a 28% reduction in emergency department utilization.

In summary, ACOs can lead to enhanced quality of care, reduced costs, and improved patient outcomes. When implemented and operated optimally, ACOs can also result in improved provider and patient satisfaction, while simultaneously improving financial outcomes for practices.

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John Ellis, DO

Vice President of Regulatory & Clinical Affairs at NextGen Healthcare

Dr. Ellis is a board-certified Family Medicine physician who serves as the Vice President of the Regulatory & Clinical Affairs team at NextGen Healthcare. His previous experience includes working as an Adjunct Assistant Professor at the Arizona College of Osteopathic Medicine and serving as the Chairman of the Family Medicine Department at Arrowhead Abrazo Community Hospital. Dr. Ellis founded his own family medicine practice in Arizona and has been using EHR’s since 2003.