Long-Term Care: Achieving the Triple Aim of ACOs with Healthcare IT

Nicole O. Fallon, Manager Consultant Health Care, CliftonLarsonAllen LLP
January 24, 2012

Long-term care providers must have a well thought out HIT strategy in place before getting into the accountable care organization (ACO) game. Despite a lot of grumbling early on, 2011 ended with greater clarity from CMS about what it means to be an accountable care organization (ACO) under Medicare. The final Medicare Shared Savings Program (MSSP) rules were published in early November; and the 32 Pioneer ACOs were announced just before Christmas. Given these developments, many long-term care and post-acute care providers are asking, "What can we do to be part of an ACO? What are ACO's strategies for post-acute services?"

There is no single way to answer this question, as each ACO has its own strategy for approaching post-acute services. Just consider:
1.    Some hospital-led ACOs are trying to figure out how to provide post-acute care themselves.
2.    Some ACOs are identifying or developing a preferred post-acute provider network
- Some are picking their "friends" -- a small subset of post-acute providers based upon longstanding relationships.
- Others are "interviewing" potential partners by asking for cost and quality performance outcomes and only sending referrals to those that meet certain benchmarks.
3.    Other ACOs are just beginning to develop their post-acute strategy.

So, What Does This Mean for the Long-Term Care Provider?
Relationships with referral partners and ACOs will always be important, but fundamentally, an ability to deliver on the Triple Aim - better health, better care, lower cost - will make long-term care providers most desirable ACO partners. Let's be honest - not every market will have an ACO operating this year or any time soon, but other markets will have multiple competing ACOs. Also - every Medicare provider will be subject to a value-based purchasing program, which withholds a portion of everyone's Medicare payments and redistributes them to high-performing providers based upon a defined set of quality outcomes measures. In either situation, providers must prepare to both provide and prove they deliver value and the Triple Aim. Ultimately, all payers - including commercial insurers and ACOs - will have certain performance expectations of providers as healthcare evolves toward value-based payment.

Health IT Can't be Ignored Anymore
Success will not be achieved with paper records in this new value-based environment. Today, providers collect innumerable information on the patients/residents/consumers they serve. To be successful going forward, providers will need to not only collect information on their patients, but also track their performance on key metrics related to cost and quality outcomes, identify areas requiring improvement, and report their outcomes. Payers, in turn, will reward or penalize them based on the level of quality provided and how satisfied patients are. Simply put, providers will need to be able to harness this information to maximize their revenues. This cannot be done with piles of paper files.

Providers will need to collect data through means that can monitor patient outcomes in real time and make adjustments along the way. If providers wait until the end of a performance year to report their results on established performance standards, it will be too late to improve. In addition, real-time information sharing with other providers in the healthcare system will be critical to improving care transitions and reducing readmissions to hospitals - both of which are fundamental to reducing the total cost of care.

Don't Wait
Now is the time to begin developing a value proposition for ACOs, which means really understanding the individual organization's performance both on cost and quality. An electronic health record can be a key tool in this process, and will be a critical success factor in a value-based payment environment. There's a lot at stake for long-term care and post-acute care providers. Measurable performance will drive both payments and referrals - and ultimately - survival of the fittest.

Nicole O. Fallon is Manager Consultant Healthcare at CliftonLarsonAllen LLP, which delivers industry-focused audit, accounting, advisory, wealth management, tax, and outsourcing services tailored for private businesses and their owners, public sector organizations and individuals.

Follow @billians

Print this page