As Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Structure (RWJF), kept in mind previously this year, Accountable Care Organizations (ACOs) are no longer the “legendary unicorn animals” they as soon as were. In just 6 short years following the enactment of the Affordable Care Act (ACA), ACOs have moved from a little market experiment to now being responsiblebeing accountable for the health care– and the healthcare costs– of almost 30 million Americans.

While ACO efficiency continues to progress, one thing is clear: ACOs were early trend-setters in the motion towards advancing population health.

But when it pertains to real operations, what does “population health” appear like in an ACO, especially in ACOs led by community health centers? Do ACOs see their role in population health management as caring for their client populations as a whole? Clients in their catchment locations? In their neighborhoods? And how do those views “sync” with the care delivery and partnership techniques that hospital-based ACOs are actually using?

The Robert Wood Johnson Foundation and Premier Inc. (in combination with Greenwald amp; Associates, LLC, National Research, LLC, and KNG Health Consulting, LLC, set out to answer these and other questions in a thorough study of ACO activities and efficiency. The study spanned from September 2015 through May 2016 and checked out population health services offered and ACO operations at nineteen hospital-based, completely integrated ACOs utilizing surveys and telephone-based interviews of ACO leaders. The results highlight manya lot of the stress that ACOs are presently dealing with.


First, the ACOs specify “population health” as attributable patient population health– implying the population health of those who come from the ACO and for whom ACOs are striving to offer premium care at lower cost. These ACOs’ focus is on patients with high, unneeded healthcare spending, such as people with intricate needs or pricey conditions. This is not an unexpected early location of focus, as these patients have the tendency to be the “heavy users” of high-cost medical services, such as the emergency situation department, even howeveralthough, with proper care coordination and management, much of this usage might be avoided and/or directed to a more suitablea better suited ambulatory setting. Usually, population health work is viewed as the purview of a particular department or program within a hospital that targets these specific kinds of clients for boosted care coordination or management.

What makes this narrow focus specifically interesting is that the bulk of the ACO leaders queried described their healthcare facilities as in an excellent or very greatexcellent position to offer resources that might enhance overall community health– yet, that wasn’t shown in their priority activities. Encouragingly, nevertheless, a number of ACO leaders described their focus on heavy users as being preliminary “low-hanging fruit” or a type of test case for modification that could be expanded to consist of other populations in the future.

A second intriguing finding was the degree to which ACO activities matched up, or did not match up, versus exactly what were recognized as the largest impediments to total neighborhood health. For instance, every ACO in the sample stated that much better behavioral health services are required to improve neighborhood health. The next most typical actions were the requirement for substance abuse services, more inexpensive prescription medications, and transportation services.

However when ACO leaders were asked what sorts of neighborhood health programs and services they were either employing or preparing to use within 6 months, the top three responses were, instead, related to care coordination, chronic illness management, and health education.

SimilarJust like the aforementioned reasoning, this suggests that lots of ACOs might be taking a “walk prior to they run” technique, developing standard ACO facilities first before dealing with more targeted community needs. It also suggests that an extra focus may be required on helping ACOs to broaden their view– and services– beyond their existing patient population.

Similarly, while 71 percent of ACO leaders are either offering, or strategy to offer, incorporated physical and behavioral health services (a handy response to the unmet behavioral health services need), less than 25 percent believe their ACOs will have sufficient numbers of behavioral health staff to satisfy their populations’ needs.

This is a considerable gap and highlights one of the major obstacles dealt with by ACOs: inadequate resources to achieve among their main objectives. It also provides some insight into why ACOs are investing first in infrastructure prior to they incorporate more specialized neighborhoodsocial work for overall health. They are attempting to buy broad-brush procedures, with expenses that can be spread outtopped the entire recipient neighborhood before they focus in on subsets of needs.

Links To Social Services

In addition, while nearly every ACO reported working partnerships with social service companies, only one in 5 ACO leaders said partnering with others to resolve social service needs was a major concern for their institutions. This disconnect might be attributedcredited to the absence of financing associated with these social service programs, cited as a barrier by 89 percent of all the studied ACOs. Simply puts, they are dealing with these social service groups, but at a more shallow level than they would if financing were no barrier. Other mentioned barriers to working collaborations consisted of bad access to services and the irregular geographic circulation of neighborhoodsocial work. However, despite these limitations, lots of ACOs are finding ways to bridge the divide in between ACO health care service providers and social services organizations.

For instance, where communitysocial work are provided and care coordination has actually been bad, some ACOs are relocating to work as the main hub to make it possible for community companies to be more reliable in fulfilling the needs of psychologically ill and chemically addicted homeowners.

Broadening ACO Reach

Likewise, in spite of insufficient funding, some ACOs are expanding their catchment areas to include other populations not consisted of in Medicare and private-payer agreements. Activities extended to these catchment areas include smoking cessation programs for patients along with caregivers; health education; evaluating the need for, and providing, required devices for patients to be monitored at housein the house in their communities; supplying care managers to helpto assist clients and their households navigate the health system; and working as a group with local community organizations to supply a collaborated action to clients’ requirements.

Numerous ACO leaders determined brand-new or expanded programs concentrating on neighborhood wellness, including partnering with employers to improve nutrition, frequency of workout, and health literacy. One ACO is partnering with faith neighborhoods and other organizations to provide training in palliative and end-of-life care.

Concluding Thoughts

In basic, ACO leaders acknowledged that the answer to broadening population health services lies in larger public policy modifications– that is, offering the resources and moneying to attend to the standard clinical, social, and mental requirements of the population in the United States.

One path forward to making it possible for more efficient population health management is in assisting regulators, funders, and patient advocacy groups to comprehend the present limitations and pressures dealing with ACOs. This consists of recommending methods to restructure current policies that keep ACOs connected to the perverse rewards inherent in fee-for-service care shipment, even as ACOs work to transition to a care model better fit for shared savings and international payments.

In addition to macro changes, there are likewise chances to much better enable ACOs to look forlook for and identify high-value health care and neighborhood partnerships to attain health improvement objectives and costs targets.

As payment reform continues to evolve, ACOs could and must be much better positioned to enhance the quality of care, costs of care, and lots of unmet neighborhood health needs.