Accountable Care Organizations (ACOs) unite primary care, specialists, hospitals and other services to provide holistic, coordinated care for Medicare patients. ACOs are charged with being accountable for patient health, giving providers within the organization financial incentives to cooperate and reduce spending by avoiding unnecessary tests and procedures.

For ACOs to work, however, providers must share information seamlessly. When an ACO successfully delivers high-quality care and lowers costs, it shares a percentage of Medicare program savings. Within this paradigm, providers can aim for larger rewards, which put them at risk of losing money if performance goals are missed, or they can target smaller, risk-free incentives.

Medicare offers several ACO programs:

Eligible ACO providers and suppliers that may participate in the Shared Savings Program include:

  • ACO professionals in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Hospitals employing ACO professionals
  • Critical Access Hospitals (CAHs)
  • Federally Qualified Health Centers (FQHCs)
  • Rural Health Clinics (RHCs)

Succeeding with HealthEC

ACOs that partner with HealthEC realize remarkable year-over-year improvements in efficiency, quality of care, costs, and quality of life for patient populations. Organizations are empowered to make more informed decisions, identify and manage high-risk and chronically-ill patients, address gaps in care, and reduce unnecessary resource utilization across the care continuum.

Aggregating Data Across Practices and EMRs

HealthEC solves one of the most fundamental challenges faced by ACOs – the aggregation of clinical and financial data across all Electronic Medical Records systems (EMRs). In fact, HealthEC has integrated with 200+ EMRs, and facilitated interoperability across 50 different EMRs within a single provider network.

Once the data is aggregated, decision support analytics identify risk and stratify the patient population. Informed leaders are better equipped to remove barriers to care, redefine care coordination, better manage ambulatory care access, evolve urgent/emergent care models, and mitigate the impact of social determinants of health.

Coordinating Care to Reduce Unnecessary Utilization

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

HealthEC’s analytics-driven care coordination tool helps clinicians actively manage care for the top 5% of patient populations that have a 4-5x risk of negative health consequences, and account for 50% of total expenditures. Care management dashboards and patient-specific workflow prompts advance high-priority care interventions that drive patient engagement and smarter resource utilization. The solution detects gaps in care and summarizes patient programs, current medications, upcoming appointments, admissions and discharges, problem lists, goals and barriers. Built-in resources include social determinants of health assessments, care team task assignment tools and value-based care program reporting assistance.

Supporting Practice Transformation

As a pioneer in population health management, HealthEC’s subject matter experts provide advisory services to guide a variety of ACO initiatives, including:

  • ACO formation
  • Determining ownership and governance
  • Organizing physician groups and services
  • Understanding cost and performance across providers and services
  • Aligning incentives with new models that create a win-win structure and scale with performance
  • Developing strategies to address the entire continuum of care
  • Designing advanced care delivery models
  • Promoting patient engagement through empowerment and shared decision making
  • Creating cost and quality transparency

Organizations that partner with HealthEC to achieve shared savings goals are able to:
  • Decrease average annual per-patient costs by up to $700
  • Reduce total inpatient costs by 6-7% annually
  • Reduce 30-day readmissions by 10%
  • Reduce ER visits by 8%, and ER visits leading to hospitalizations by 12-16% year over year
  • Reduce Skilled Nursing Facility costs by 33% per assigned beneficiary