5 Ways ACOs Align Perfectly with Population Health Mgt


5 ways ACOs align perfectly with population health management

In the not-too-distant future, Medicare is likely to move between 80% and 90% of medical payments to be “at risk.” This means more potential savings, along with more potential risk. It underscores the need for accountable care organizations (ACOs), which were designed to maximize care quality while minimizing cost.

But ACOs have a further benefit—they were designed to drive population health management. They incentivize a clinically integrated network to open possibiliites for proactive care. They promote care coordination to refine resourcing across the continuum. And they encourage strategic investment in less expensive care settings to maintain wellness more efficiently.

The lab is not a passive stakeholder in this transformation—it is a vital driver. ACO success and value-based care cannot exist without lab data as well as laboratorian partnership.

Article highlights:

  • As medical payments are quickly moving to be “at risk,” institutions need to be more accountable for population health management
                                      
  • ACOs are proving to create much-needed value in achieving population health goals

  • The lab is a key driver in realizing better outcomes population-wide, while driving institutional value


Read on for expert insights on how ACOs align perfectly with population health management—and how the lab is needed to support each layer.

Contributing Lab Leaders

Les Duncan

Les Duncan

Current Director of Operations
Highmark Home & Community Services, Highmark Inc.
Former Vice President of Accountable Care Initiatives
River Health ACO, Pinnacle Health

Michael Astion, M.D., Ph.D., HTBE

Michael Astion, M.D., Ph.D., HTBE

Medical Director, Department of Laboratories
Seattle Children’s Hospital
Clinical Professor of Laboratory Medicine
University of Washington Department of Laboratory Medicine

Richard Gentleman

Richard Gentleman

Senior Director 
National Contracting and
Accountable Care Solutions
Aetna

Peter Gross, M.D.

Peter Gross, M.D.

Chair at Hackensack Alliance
ACO Board of Managers
Professor of Medicine, Preventive Medicine and Community Health
Rutgers New Jersey Medical School

Joel Shu, M.D., MBA

Joel Shu, M.D., MBA

Vice President
Clinical Transformation
& Population Health
Catholic Health Services

1. Identification and stratification

Having more robust data sets creates amazing treatment possibilities. Consider the following flow chart—ACOs empower health care institutions to do all of these things.

Identify deseases > Identify risk factors > Stratify population image

With better identification and stratification, you can better understand how different patient types can get ahead of diseases. This is critical to providing “well care,” while avoiding devastating and costly disease progression.

What can the lab do to help?

Data are only valuable if they are actionable. Ensure your data are standardized, and invest in tools such as middleware to amplify your data intelligence.


2. PCP is the quarterback of care

With more integration and more data, a new possibility arises—more complexity. Who is responsible for “owning” the patient relationship? Directing treatment? Overseeing activity? Without a centralized “quarterback,” it can become increasingly difficult to remain accountable over care. And this would create an incredible disservice to population health management.

Fortunately, within an ACO model, your quarterback of care is clear—the primary care physician (PCP). These vital team members are in a natural position to take control of patient health and help to proactively ensure it.

Get to know the multiple benefits of putting your PCP at the center:
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Overall, PCPs are able to see the big picture of patient health. This uniquely empowers them to drive quality and efficient care, which is fundamental to managing populations.

What can the lab do to help?

The lab can help ensure PCPs are receiving the data they need, in the format they need. Make yourself available to help them interpret the values. Your partnership will empower them—and therefore the entire care team—to gain traction in population health.

3. Support longitudinal care

Consider this insight from Les Duncan: “So you're not taking care of the patient just when they're in front of you with an illness in your office, but throughout their continuum of life. You want to take care of these people not just when they have the flu, but you want to make sure they're taking their meds, that they're compliant, that they are well-fed, that they have someone in their home that cares about them.”

Duncan is not only articulating the mission of ACOs but an evidence-based approach to population health management. And it all comes down to data.

Data highlight the bridges between isolated episodes of care. By accessing data across a patient’s history, you pave the way to initiating a more seamless care approach. This means going beyond treating illnesses to proactively preventing them and their progression.

By facilitating more insights about longitudinal patient health, ACOs enable care teams to expand their reach and drive wellness from the start.

What can the lab do to help?

Data are the lynchpin of longitudinal care, which puts you in a position of power. Emerge as a data specialist and you’ll make yourself an invaluable clinical consultant (you’ll support greater outcomes too).

4. Refining physician performance across locations

Physicians may have the same clinical information but go about treatment in very different ways. This lack of standardized protocols denies best practices and poses a challenge to population health.

ACO data are the cure. They don’t just point to patient outcomes, but how physicians are facilitating them.

  • Which physicians are maximizing health?

  • Which physicians are minimizing costs?

  • Which physicians are slashing treatment time?

  • Which physicians are reducing readmissions?

Illuminating these insights is pivotal to driving evidence-based care, and ACOs are optimized to enable it. Once you identify best practices, you’re in a leading position to refine care across specialties. What supports population health better than that?

5. Identifying programs that can help

Managing the health of entire populations requires a high degree of operational excellence, and ACOs catalyze this. To meet quality standards, they incentivize institutions to step back and look at the big picture of process and performance. This can usher in new programs that drive cost-efficient, quality care.

Let’s look at two programs Dr. Astion is recommending to drive population health.

Optimizing test utilization

Dr. Astion recognizes the negative impact of testing overutilization. He states, “at my institution, half the time a patient cannot pay.” This is compounded by excessive tests being ordered. What’s the immediate result? His institution has to cover the payment. But what’s the greater impact? “Our ability to deliver an emergency hemorrhage panel to a bleeding patient is affected by these millions of dollars of unnecessary genetic testing that we have to pay out of pocket.”

This inspired Dr. Astion to develop his PLUGS program (Pediatric Lab Utilization Guidance Service). He helped his institution develop genetic test utilization management systems to ensure physicians are only ordering necessary tests. Based on the success of the program, 50 hospital systems went on to join PLUGS.

Results retrieval

According to Dr. Astion, “about 5% of lab tests are never retrieved.” To complicate matters further, “when you’re transitioning care from inpatient to outpatient, that’s a big Achilles heel of retrieval.” Dr. Astion urges the lab to partner with their IT department to co-create systems that help ensure results retrieval. We’ll take a deeper dive into this topic in an upcoming LabLeaders article.

What can the lab do to help?

Every program starts with data. Review claims and outcomes data (both of which are in abundance at an ACO) and make a business case for an inspired care program. Not only will it ladder up to ACO goals, but it will reinforce your own value in driving healthy populations.

It all comes down to data

As we discussed the many ways ACOs align perfectly with population health management, one thing should be abundantly clear: Data are indespensible. And with data, you can make your lab indespensible.

It’s incumbent upon you to reinforce your value every day. Find clever ways to drive quality and slash costs. Identify opportunities to standardize best practices and optimize physician performance. Brainstorm programs to put care improvement into action.

The tools are at your fingertips, and ACOs incentivize using them to make your populations healthier.


Additional resources

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