How to Optimize Your Transition to an Accountable Care Organization (ACO)
Russell FaustWhat is an Accountable Care Organization (ACO)?
To over-simplify, an ACO is a capitated care model for medical care reimbursement. In this most recent version, we are told, the risk will be shared by the hospitals and physicians. We’ll see.
We’ve been there before. It didn’t work then. It may not work this time, either. But that won’t keep the ACO model from being implemented. Like it or not, it’s coming your way.
So, let’s face reality and make the most of it for your medical institution or practice.
The Past
Fee for service has been the model of medical care reimbursement for decades.
This is a “Volume-based Revenue Model”.
This model drove traditional marketing strategy.
Let us look at a couple examples:
- Advertise a free stress test as part of a healthy-diet program; identify those with potential for cardiovascular disease, schedule a subset of them for angiograms; schedule a subset of those for bypass procedures or for cardiac vascular stents. All big-ticket CPT. High-level RVU. High reimbursement.
- Advertise free physical therapy for knee and hip pain; identify those with degenerative joint disease; schedule those for knee and hip replacements. Big-ticket CPT. High-level RVU. High reimbursement.
- Advertise free weight-loss clinics. Offer free information seminars on bariatric surgery program. Some patients will elect to proceed with bariatric surgery. Big-ticket CPT. High-level RVU. High reimbursement.
These folks are mostly elderly, with chronic diseases. Their bodies are wearing out, and they are ripe for the wonders of modern medicine. Attracting an insured population of elderly or ailing into the hospital for procedures can be lucrative under a fee for service model.
The medical industry has grown by treating sickness. Not by creating health.
There is a huge difference.
If we – the physicians and the hospitals – share the responsibility for the long-term health of our patients, treating sickness can bankrupt us.
It is time to focus on preventing disease, creating health, and maintaining wellness.
The Future
The goals for the ACO model are laudable: prevention of chronic disease, minimizing invasive procedures except as the last resort. The goal of ACO paradigm: maintain a healthy community, with overall reduction of healthcare expenditures.
Accountable Care Organizations can thrive only if the balance of their patients is tilted toward relatively healthy patients. But they will need to cover all comers, young and old, sick and well.
The way for ACO’s to stay in business is to keep people healthy!
Under this model, we don’t want to treat disease. We want to create and maintain health. Hallelujah!! It’s about time. The challenge for survival will be in the details of implementation.
Those healthcare systems that embrace this new paradigm by implementing programs to prevent disease, and promote and maintain health, will not only survive. They will thrive under the ACO model!
How can YOU move in that direction right now?
Are there steps that you can take now that can improve your care of patients, AND help keep you in business, regardless of how long it takes the ACO model to be implemented (whether it is ever implemented)?
Let’s compare the old and the new marketing strategies:
- The Old Strategy was volume-based: drive volume of patients needing high-charge services. Under ACO paradigm (capitation), those patients will lose money for the healthcare system.
- The New strategy is value-based: Drive a volume of healthy patients. Keep ‘em healthy to make a profit … the Value-based Revenue Model.
How?
Well, NOT by marketing to bring in all of the sickest patients that you can find or to advertise your latest cardiac unit, your coolest robotic surgery center, or how great you are at the latest wonder of modern medicine.
Under ACO, you want every person within our healthcare system to be as healthy as possible.
You can’t get there by “marketing” in the traditional sense. You can no longer “market” your latest, coolest, expensive technology. You can’t market your treatment of disease. Instead, you must “market”health. You must get your communities healthy, and keep them there!
How do you get there?
Two Steps to Take:
1) Connect With Your Patient Communities
Aside from the one-on-one time we spend in our clinics, most of us have typically tried to connect with our patient communities through traditional marketing or PR programs. That can be problematic: it’s unidirectional, sending out a message, not real engagement or interaction. It’s not social. It’s largely ineffective.
The way to truly CONNECT with our communities is through social networks. As the name implies, their advantage is that they are SOCIAL. And most importantly, our patient communities spend time on these social networks. As one example, 95% of US internet users are on Facebook (Blogher, April 2011).
Many of us consider use of such social networks to be the realm of teenagers. In contrast to this popular notion, Pew Research suggests that nearly half (46%) of Facebook users are aged 45 years and over! The percentage of this age group (>45yr) on the other social networks (Twitter, Google-plus, LinkedIn), is even greater!
Therefore, the first step to optimizing the transition of your organization to ACO’s is to establish a strong connection with your patient communities. Implement a strong, integrated Social Media Program into your existing communications, marketing, PR programs.
Next, what to DO with that connection??
2) Use That Connection to Get Them Healthy!!
This requires changing behaviors of those in your communities. Changing their lifestyles. This is a whole new way of interacting with our patient communities.
A whole new way of thinking.
It will no longer be viable for a hospital to merely sit back and accept sick patients. In the ACO era, that strategy will lose you money. In the ACO paradigm, that old strategy will risk your very survival.
In the ACO era, it will be essential to practice true outreach.
Programs that go out into the community and get them healthy, and keep them healthy.
Free clinics / seminars that support health in areas such as:
- prenatal,
- weight control,
- fitness;
- smoking cessation;
- stress management;
- alcohol and substance abuse;
- healthy back care;
- nutrition;
- hypertension;
- diabetes.
These programs will cost money.
That is the first thing to accept – the cost.
But study after study has demonstrated that preventing disease – and maintaining health – is MUCH less expensive than treating disease.
Again – there was no incentive to do that when we were paid to treat sickness.
And in the ACO model, it will be the hospital and their partnered physicians who will accept that risk – the expense of treating disease.
Implementation of “Obamacare” means that by 2014 hospitals will be ACO’s – by that time, hospitals will only make money if they learn to keep people out of the hospital!
Not by keeping sick patients out, but by keeping communities healthy. Not by denying care, but by promoting health and wellness.
These activities – connecting, and wellness – need to merge, need to work together.
The other change from traditional marketing that we need to accept: As mentioned above, our patient communities now live online.
They live in the digital world.
In order to engage them, we must have a presence in that world. If that means having a presence online, then that’s what it takes. If that means setting up a Facebook page, or a medical education blog, or a Twitter account, or a YouTube account to post informative videos about our practice or hospitals, then that is what it will take.
Is that enough?
Is it sufficient to simply open a Facebook or Twitter account?
Of course not!
Establishing a presence in the online world requires more than merely opening a few accounts. It requires actually being present in that world. It requires engaging your communities in that world. It requires answering their questions, helping them find answers, helping them get information to make their lives easier, helping to educate them regarding their health.
That is what is meant by a whole new approach to “marketing”.
Don’t think of it as marketing.
Think of it as engaging your patient community.
There are great models for hospitals that are connecting with their communities in the digital world, including the Cleveland Clinic, and of course, the Mayo Clinic.
These institutions demonstrate ‘best practices’ for how to connect with their communities in the digital world. They are present and active at multiple sites, on multiple “platforms” online. They are engaged, and connecting and influencing their patient communities. Already. Long before 2014.
In Between Past and Future:
What to do Right Now?
- Embrace programs for health and wellness.
- Embrace prevention programs.
- Embrace early detection programs.
- Embrace education programs.
- Embrace cost-effective evidence-based “complementary and alternative” programs.
There are many examples of wellness programs, and complementary medicine programs – acupuncture for management of stress, for control of back pain, pain associated with various cancers, for smoking cessation, for weight loss, for diabetes control, and many other health challenges.
What else do you need to do?
- Engage the individual,
- and also the whole family
- and the whole community
Embrace programs that support
- long-term changes
- long-term improvements
- programs that maintain health
Where Does Integrative Medicine Fit In?
You may already be familiar with health and wellness programs; you may already have some of these programs in your healthcare system. Some healthcare systems have quietly been implementing wellness programs under the label “Integrative Medicine Center” for years.
[Integrative Medicine combines the best of conventional and alternative remedies: according to the National Institutes of Health, Integrative Medicine includes remedies that “combine mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.”]
There are great models for hospitals that have Integrative Medicine Centers, including the Scripps Institute, Duke, and the University of Maryland. See these Centers for “best practices” with regard to prevention, health, and wellness. These Centers are leading the way to truly connecting with their communities, creating long-term changes in healthy behaviors, and providing cost-effective healthcare.
For most of these institutions, it is rare that their Integrative Medicine Center is a revenue-generator. They have largely been ignored, barely tolerated, and looked down upon as unworthy money-losers. In the fee-for-service era, in the conventional high-tech, high-CPT, high-RVU world of volume-based medicine, these programs were the poor step-child.
As Healthcare Reform is implemented, and ACOs become the new standard, these Integrative Medicine Centers will be the bridge to viability for these institutions.
To Summarize
Surviving under the new model of healthcare will require a new culture for your institution. A culture that integrates a social connection with your community into existing programs, and a culture that uses that connection to bring your community to health, and to keep them healthy. Nobody does this better – connecting with their patients community, and keeping them healthy – than Integrative Medicine Centers.
It’s time to start thinking of your patient community simply as your community. Because, if done right, you’ll keep your community healthy and few will become actual patients.
Start to implement these programs NOW.
Be the source of healthy lifestyles for your communities.
Be THE ADOCATE for your communities.
The Digital World, the New Media, not only makes this possible. The digital world makes this essentialfor your practice and hospital to survive and thrive.
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Resources
- Healthy Lifestyle Awards:
http://www.businessgrouphealth.org/pressrelease.cfm?ID=158
See this list of employers for some companies with great wellness, health and prevention programs.
- 4 Ways to Think about ACO Strategy:
http://www.healthleadersmedia.com/print/PHY-259945/4-Ways-to-Think-About-ACO-Strategy
An outstanding article. Erudite, yet lucid.
- Attracting Primary Care Providers to Your ACO:
- The American Board of Integrative Holistic Medicine – combining the best of alternative and conventional medicine for the wellness of your community:
Reader Comments (1)
Very important post. The key to the future of medical care delivery is to focus on health and wellness to prevent chronic illnesses - which consume 70+% of all health care expenditures. They are preventable but it takes time and effort of the type outlined here.
And for those who already have a chronic illness, the key is good primary care in an integrative setting, again as discussed above, to assure that each patient has excellent coordination of the care that they receive. This adds to quality and markedly reduces expenses overall.