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Strategies to navigate ACO setbacks

By Signify Health Team on 10/16/23 11:21 AM

Accountable care organizations (ACOs) have proven to help position providers, hospitals, and health systems enhance the patient experience, improve patient care outcomes, and lower or contain costs while generating new revenue. The success of value-based care has been so significant that in 2021, the Centers for Medicare & Medicaid Services (CMS) established a goal to have 100% of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries enrolled in ACOs by 2030. 

While healthcare based on value rather than fees has a different structure, value-based care and fee-for-service healthcare share a common denominator: fluctuating performance. As the nation’s providers continue to transition to accountable care, having an understanding of the nuances of value-based payment models, including the methodologies and workflows that are solution-specific to adjust for variances, is essential. 

For more than a decade, Signify Health has provided support and resources so health systems and providers who participate in the Medicare Shared Savings Program (MSSP), ACOs are positioned to succeed. Our proven, value-based care model is strategically designed to utilize a team-based approach that maintains a continuity of patient care and helps mitigate risk so the ACO and their providers are positioned to earn shared savings.  

Despite noted success in accountable care, some providers question whether joining an ACO is right for them. Some have independently participated in an ACO without the benefit of proven strategies, workflows, technology, and training from value-based care experts. Signify Health ACO experts have talked with healthcare teams of all sizes and in all locales that have tried or are trying an ACO on their own but have yet to realize success. Below are five primary causes of ACO setbacks and the solutions that have effectively navigated fluctuations and paved the way for success.

1. Going it Alone Without a Sufficient Infrastructure

The do-it-yourself (DIY) approach to value-based care can entice ACO leaders who believe they have the knowledge and necessary resources to implement and succeed in accountable care. While we encourage a confident, entrepreneurial spirit, the DIY approach is flawed. 

Health system leaders and providers may appear to understand that venturing into value-based care alone can expose organizations to risks, but they almost always underestimate the cost(s) of failure and the gradient of the learning curves for initial and sustainable success. Signify Health ACO experts have developed a roadmap that has been proven successful and built on several fundamental elements, including: 

  • Accountability
  • Governance
  • Award-winning technology
  • Population health workflows 

Instilling and building on those core elements, we tailor the roadmap to each organization’s unique needs that provide specific support to render success.

2. Lack of (Non-Negotiable) Physician Buy-in 

A properly functioning healthcare system requires collaboration between health systems, hospitals, and providers and is crucial to coordinating care and improving patient outcomes.  Without internal—and external—collaboration, lowering costs is nearly impossible. Collaboration is crucial.

While other ACOs fail to mandate physician buy-in, Signify Health requires and actively fosters it.  We emphasize the importance of creating an environment where participants and their providers and staff fully comprehend the value and benefits of the initiatives and the potential for patients and the organization.

  • We optimize team-based approaches, positioning and encouraging physicians to spend more time with patients. 
  • We supply ample educational and peer-to-peer learning opportunities to ensure physicians have the requisite support.

3. Failing to Iterate on, Optimize, and Augment Core Components

Many failed ACOs correctly identify the three core elements of value-based care success: Annual Wellness Visits (AWVs), Chronic Care Management, and complete and accurate documentation. However, once implemented, they check the box off their list and go no further. Successful ACOs consistently go beyond the initial implementation steps and continually iterate and optimize workflows and resources to achieve the best possible outcomes.

In addition to having access to our award-winning technology, Signify Health’s ACO participants have the benefit of: 

  • New technological features and workflow updates that enhance the core components for success. 
  • A proprietary AWV Impact Score that quantifies how well our provider partners maximize the AWV to ensure complete and accurate documentation coding and to address quality and care management opportunities. 
  • Access to valuable experience and insights regarding care team initiatives and care delivery. 
  • The ability to course correct by identifying areas of improvement through enhanced data analytics. Through data and group coaching, providers can better understand what's working and where improvements can be made. 

The easiest path to ACO failure begins with a Set-it-and-Forget-it approach.

4. Technology Misalignment: Implementing Technology that Doesn't Suit Your Organization's Unique Requirements

Investing time and resources in technology that doesn't align with your organization’s unique needs can be costly. ACO success requires alleviating demands on each provider and effectively tracking and managing financial performance. And that requires all-in-one, comprehensive technological solutions that are customizable to your organization’s needs and can be seamlessly integrated into the workflows of providers and staff. 

Coach, Signify Health’s provider enablement platform, has demonstrated to be a reliable and user-friendly tool for ACO success. 

  • Coach is payer-agnostic, permitting participation in ACOs with Traditional Medicare beneficiaries, Medicare Advantage beneficiaries, and Commercial insureds regardless of the payer (CMS, Aetna, Humana, etc.). 
  • Irrespective of payer involvement, healthcare teams have the tools, processes, and resources required for their ACO success. 
  • Providers use Coach to stay aligned and on track with performance objectives.

Failed ACOs often implement technology that, while helpful, is not aligned with the organization’s success. Value-based care technology is not a one-size-fits-all solution.

5. Insufficient Scale: Bigger is Better When it Involves Attributed Lives

Scale has proven to be a pivotal factor in predicting the success of an ACO. Our experience with ACO performance shows that an essential ingredient to stable and predictable financial outcomes is serving a larger population of beneficiaries. With a sizable number of attributed lives, ACOs are less susceptible to random variations in savings. For example, scale can prevent negative performances due to a particularly bad flu season in the Northeast that is not present in the Southwest. The scale ultimately leads the ACO to more accurate and reliable results. 

Validating the fact that ACO size is a critical component of value-based success is  Signify Health's collaborative ACO model, which has saved Medicare more than $585M since 2015.

  • Scale provides stability in risk-based payment arrangements within a collaborative model.
  • With the advantage of scale, Signify Health’s Enhanced Track ACO participants  earned $57 million in 2022.

Value-based care is the future of our nation’s healthcare system. Providers and health systems are successfully transitioning to accountable care models that enhance the patient experience, improve patient care outcomes, and lower costs while generating new revenue. Performance fluctuations in the field of healthcare are nothing new. Having accumulated more than a decade of expertise in value-based care, Signify Health’s experience demonstrates that by having proven workflows, resources, technology, training, and data analyses, ACOs can thrive regardless of variables. 

Signify Health continually innovates to ensure our ACO participants have the tools, resources, and support necessary to coordinate care, improve patient outcomes, minimize costs, and succeed with value-based care. Avoid ACO pitfalls by joining Signify Health’s leading value-based care experts with decades of proven success operating, managing, and supporting ACOs.