With many providers currently assessing the viability and strategy to become an Accountable Care Organization (ACO), our team has been gauging what a successful ACO might look like in the post-healthcare reform world.
To know what one might look like, denotes having a handle on its core IP. And while many healthcare consultancies (both large and boutique) are attempting to map out strategic plans for their provider clients; the capabilities, resources and systems that providers must implement to become true risk-bearing entities is complex. Yet, we’ve boiled it down to two core competencies which will be table stakes for success.
Care management/care coordination – Leveraging capabilities that extend the providers reach into the day-to-day lifestyles of their patients:
- Prospective medical home assessments
- Chronic care coordination
- Critical care interventions
- Remote-patient monitoring
- Data-driven healthcare communities
- Provider network coordination
Data analytics/decision support – Establishing a 360° view of the patient condition to establish appropriate, patient-centric profiles
- Data mining
- Decision support
- Evidence-based medical rules
- Behavior-based messaging
- Real-time analytics monitoring
While these two competencies have generally been managed by health plans – with the help of many third-party technology-enabling solutions – we think they will need to become core components for providers interested in sustaining a successful ACO. Beyond the sub-components listed above, our research also underscores risk for these providers, and moreover their ability to manage it.
The risk bearing providers of the future will likely address these components similar to the way health plans do it today, but the ACO model will promote better utilization. We’re in the midst of finalizing our research agenda our informatics and decision support for a formal Report Q2’11…it would be great to know what you think about this dynamic, high growth arena.