How Accountable Care Organizations Can Hit the Quadruple Aim Bullseye

Dan Hoemke, EVP, Value-Based Healths Solutions, BaseHealth

“The real opportunity to hit the quadruple aims bullseye is found in the unknown, rising risk population.” — Dan Hoemke, EVP, Value-Based Healths Solutions, BaseHealth

The train has left the station and there’s no point looking back at a pre-value-based care world.

Accountable Care Organizations (ACOs) are putting a tremendous amount of energy into achieving the quadruple aim: bending the cost curve, improving clinical and care management outcomes and delivering a superior member/patient experience. And rightfully so! The Centers for Medicare & Medicaid Services (CMS) has made the shift all but required through value-based initiatives.

In the new value-based world order, ACOs and health systems will need to be vigilant about keeping costs associated with high-utilizers in check — of course. But typically, these patients who have already reached a high intensity level, will remain high utilizers regardless of any intervention.

The real opportunity to hit the quadruple aims bullseye is found in the unknown, rising risk population. A group at BaseHealth we refer to as the “Invisible Patient,” these individuals don’t have long, complicated claims histories. They look healthy on paper, but they are in fact at risk of disease and have a high risk of falling ill within the next 6–12 months.

ACOs’ three-legged stool

So, if you’re an executive at an ACO who — like many others — is nervous about the risk your organization has taken on, where do you throw your darts? Think in terms of three parts — each of which are necessary for your value-based care program to stand upright.

1. Gain visibility. You need to understand your population — where you’re bearing risk, what your financial exposure is and what your costs look like for the next 12 months. Traditionally, this has been done actuarially. But BaseHealth technology, powered by artificial intelligence, can provide visibility more quickly and more accurately using other data sets, enabling you to understand what diseases are most likely to occur in your population and what the specific risk factors are.

2. Take control. You need to strategically and tactically mitigate the financial risk — or avoid it altogether. One approach is to find rising risk patients and target valuable intervention dollars on improving their care to prevent diseases before they start. Another is to evaluate your member population come January 1 and encourage those high-risk patients to see a doctor sooner rather than later so undiagnosed diseases are discovered, RAF scores accordingly adjusted, payments from CMS increased earlier in the year and most importantly — members are better cared for.

3. Manage and measure. After you’ve developed a strategy and plan for effective intervention, track the progress of your program, measure the return on your investment and continually optimize performance.

I’d argue that the majority of ACOs don’t have an adequate capability in any one of these three areas. Does yours?

Tomorrow, BaseHealth CEO Jason Pyle will join Dr. Barrie Bradley, Director of advanced analytics and clinical performance at Banner Health, to discuss how risk stratification can improve population health infrastructure at the 4th Annual ACO Strategy Summit. If you’re attending, join them to hear how Banner Health uncovered their rising risk population, and how you can do the same.