As participation in accountable care organizations (ACOs) continues to grow, one thing is certain: value-based care is the future of U.S. healthcare. The Centers for Medicare and Medicaid Services (CMS) is still adhering to its plan to enroll every eligible beneficiary in an accountable care arrangement by 2030.
These goals look great on paper, and stakeholders across the U.S. healthcare industry have made appropriate strides to adopt VBC. But the road ahead still presents challenges to ensure that every patient has equitable access to high-quality, affordable care. Risk-based models incentivize providers and payers to focus on actions that have a measurable impact on reducing the total cost of care while improving quality and outcomes.
With increased emphasis on accountable care models, including ACO REACH, ACO Primary Care Flex, and Medicare Advantage, three of healthcare’s most influential industry groups – AHIP, AMA, and NAACOS – recently shared “best practices” from ACOs with demonstrated success over the past three to five years in a joint publication, Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements. Cedar Gate’s technology aligns clearly with these best practice recommendations and can simplify ACO administration and management for organizations in a wide variety of risk-based models.
“Accurately identify the population for which a VBC entity or participating practice will be held accountable during a performance period; honor patient preference wherever possible.” – AHIP, AMA, NAACOs joint report
Eliminate the need for manual spreadsheets with automated tools to align beneficiaries with the right providers. Cedar Gate ingests data from CMS, including beneficiary alignment files, making it easier to track all aspects of patient attribution. ACOs can use the tools to track enrollment, assign patient panels to appropriate providers, and reconcile payments based on patient alignment from CMS or commercial payers.
“Predictably, accurately, and transparently [set] an achievable spending target and … create a path toward sustainable savings over the life of the VBC payment arrangement.” – AHIP, AMA, and NAACOs joint report
Past performance is one indicator of future performance, but there are a lot of variables in healthcare that could impact performance in a risk-based model. Cedar Gate’s analytics tools predict ACO model performance on financial and clinical quality goals using historical data, aligned with the characteristics of an attributed population. Forecast multiple scenarios to determine the ACO model that works best for your providers and population needs. Additionally, the tools provide ongoing analysis and forecasting for the current performance period, so providers and payers can identify areas of improvement and make a difference prior to the end of a performance year.
“Incentivize quality improvement and sustain long-term high-quality care; [incorporate] quality performance … to counterbalance competing financial disincentives related to lowering avoidable or unnecessary costs.” – AHIP, AMA, and NAACOs joint report
Analytics software from Cedar Gate provides valuable insights on your patients or member populations, but it also helps uncover provider performance metrics to keep ACOs on track with VBC program goals. Use the tools to identify underperforming providers and facilities, identify the cost and quality levers available to improve performance, and assign appropriate resources to turn around poor performance.
“Non-financial incentives including access to pertinent and timely data, reducing administrative burden, and increasing transparency around performance metrics are all critically important to incentivizing broad participation and achieving the goals of the VBC payment arrangement.” – AHIP, AMA, and NAACOs joint report
Cedar Gate’s report and dashboard tools make it easy to share information among all stakeholders in an ACO agreement. Transparency and data sharing – with appropriate safeguards to protect patient privacy and organizational security – are essential to build trust among ACO partners. With our advanced reporting tools, organizations can build customizable dashboards to keep critical KPIs and insights at the forefront. Share contract performance measures, reimbursement parameters, and progress toward goals with every provider in the ACO. Users can easily drill down into the data behind each metric to see how it was calculated and what’s included in the measurement.
The AHIP-AMA-NAACOs report includes a deep dive into these and other best practices, highlighting what is working for the most successful ACOs. Check out the full report for details, and talk to Cedar Gate to learn more about the only end-to-end software suite specifically designed for value-based care and ACO REACH success.
