While most accountable care organizations (ACOs) report having comprehensive chronic care management processes and programs to manage patients with complex needs, there are few advanced programs and labor-intensive interventions, according to a report by The Commonwealth Fund (CF). The report examines the organizational strategies, contracting details, and leadership structures undertaken by ACOs in their care of complex patients.
Care for patients with complex needs. ACOs are intended to provide high-quality care while controlling costs and may focus on patients who require more resources and who are at higher risk for encountering serious problems with their care. Such patients account for one-fifth of health care spending but comprise only one percent of patients. Complex patients have multiple chronic conditions or functional limitations, have conditions that carry significant nonmedical needs, or are frail older adults. Care for these patients requires the coordination of numerous providers, family caregivers, and social service agencies.
ACOs present an opportunity to improve the quality of care and lower costs for people with complex needs. ACOs pay bonuses tied to cost and quality performance for their patients, and with the incentives to reduce cost and improve quality, ACOs often employ care management programs that follow evidence-based strategies for increasing the value of care. These include identifying patients who are at high risk for adverse clinical events, separating high-risk patients into subgroups with common needs, improving care transitions across settings, engaging individuals and families in care decisions, and using programs that help patients address chronic illness.
Survey results. To gauge the care provided to patients with complex needs, CF analyzed responses to the fourth wave of the National Survey of ACOs, which was conducted in 2017 to 2018. CF found that 63 percent of ACOs reported having comprehensive care management programs and processes, while 33 percent reported only having "some" care management programs in place. More than half of ACOs (52 percent) reported comprehensive care management programs with an advanced system in place to identify and target patients with complex needs, allowing the ACOs to funnel limited resources where they are likely to have the greatest impact. Most ACOs (66 percent) reported segmenting high-risk patients into subgroups based on common needs, which allows the design of more effective interventions.
Despite being a prominent component of evidence-based care transition models, only 21 percent of ACOs with comprehensive care management programs reported that patients received an in-home follow-up visit within 72 hours of discharge. The use of labor-intensive programs in notably lower in ACOs without comprehensive care management programs.
Companies: The Commonwealth Fund
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