When a healthcare provider seeks to take on greater risk in a value-based environment, an important preliminary task invariably will be to expand its care management and data analytics capabilities to manage its patient population. However, smaller provider organizations such as physician practices tend to lack the IT infrastructure, analytical tools, and manpower to build out these capabilities on their own. Such was the case for Mississippi cardiology practice that wanted to embark on a value-based payment initiative but faced a challenging uphill battle in obtaining these necessary capabilities.
To address this challenge, Cardiology Associates of North Mississippi (CANM) in Tupelo, Miss., collaborated with a direct-to-provider partner to leverage clinical best practices and innovative technologies to improve cardiac care for its patients. The initiative resulted in the nation’s first cardiology accountable care organization (ACO), Accountable Cardiac Care of Mississippi (ACCOM). ACCOM contracts with a national insurer to provide shared-savings opportunities for CANM’s cardiologists.
As ACOs continue to develop across the nation, analysts predict the number of covered lives will increase from more than 20 million to more than 105 million by 2020. This increasing number of lives cared for within ACOs intensifies the pressure on both specialty and primary care physician practices to move toward these value-based payment models, leading them to explore strategic partnerships such as the collaboration that led to the formation of ACCOM in efforts to improve care for complex patients. Such partnerships better position practices to enter into risk-based contracts by providing access to claims data analysis expertise and tools that boost capabilities for case management, utilization management, and more.
Health systems and provider practices alike must consider many factors when taking on risk and ultimately sharing savings, and forming strategic partnerships adds an additional layer to these considerations. The experience of ACCOM suggest that the following four areas of focus provide a good starting point for such a collaboration.
Improve behavioral health screening capabilities. Treating patients with chronic disease becomes even more complex when these patients also are dealing with a behavioral health condition. One out of five people in the United States experience some form of mental illness, yet 30 percent of patients with behavioral health issues do not receive treatment for these conditions. Research shows that integrating care for physical and behavioral health, especially among patients with complex care needs, can significantly reduce healthcare costs. Some strategic partnerships between behavioral health experts and physician practices have led to tools that allow providers to accurately diagnose patients with behavioral health issues. The results provided by these tools allow providers to better assess the severity of patients’ behavioral health needs and engage patients in receiving treatment at the most appropriate level of care.
Provide online treatment options for behavioral health conditions. For example, some practices partner with direct-to-provider care services companies to offer self-guided digital cognitive behavioral therapy (DCBT) modules—with outstanding results. Eighty percent of patients who receive treatment for behavioral health conditions such as anxiety, insomnia, depression, substance abuse, chronic pain, and obsessive-compulsive disorder report improvement within 30 days. DCBT modules also offer increased convenience for patients, with the ability to complete sessions at their own pace through their computer or smartphone. These modules also are a clinically proven alternative to prescription drug treatment for health issues such as chronic pain management.
Expand options for telehealth access. Partnerships with telehealth providers increase access for patients with complex needs, especially upon discharge from the hospital when the risk for readmission is high. By leveraging telehealth to answer patients’ medical questions off-hours and direct patients to seek urgent treatment, where appropriate, physician practices can reduce readmissions for chronic conditions. Some providers also offer patient-to-provider texting services to address patients’ immediate health needs.
Offer wraparound case management services for complex conditions. In communities with limited resources for one-on-one care support, a combination of virtual and in-office case management services provides the basis for an integrated care approach. For example, virtual case managers can serve as the patient’s first point of contact during treatment for chronic conditions. They also can assist physicians and staff in detecting the warning signs of health issues that, if not treated, could lead to complications. Such services drive positive health outcomes and an improved patient experience while reducing readmissions.
Partnerships for Value
Models such as ACCOM leverage strategic partnerships to take advantage of economies of scale while offering providers the ability to customize solutions for high-risk populations. In an era of value, both primary care and specialty care practices should consider strategic partnerships that enhance their ability to integrate care for patients with complex needs while improving care quality and costs.
Jim Wieland is senior vice president of product innovation, Magellan Health, Scottsdale, Ariz.