The Best Tip in 2022 to Optimize Your ACO Performance: A Smart Referral System That Allows You to Track and Co-manage Your At-risk Patients

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Providing coordinated high quality care without a hitch; reducing hospital readmissions; preventing errors during patient care; protecting the resources of time and money for at-risk patients, doctors, and payers as a whole. While most providers can agree that these are smart goals for healthcare professionals, Accountable Care Organization (ACO) take it one step further: they make it their immediate mission to achieve them. A successful ACO is made of many moving parts; the ability of provider groups to communicate clearly with one another about a patient’s care can mean the difference between quality improvement, seamless care, and complete mismanagement. Be sure to consider ACO’s quality performance score as well quality performance standard . So, what does that seamless care look like in the hands of ACO’s, and how can an efficient network support their mission?

ACO Explained – A Medicare Program

Medicare was created in 1965 as a health insurance program for Americans over the age of 65. The program was designed to help seniors pay for medical expenses, including doctor visits and hospital stays. In the early 1990s, Medicare began to experiment with a new type of healthcare organization called an Accountable Care Organization (ACO). Since its inception, the Medicare ACO program has grown rapidly. As of 2016, there were more than 530 Medicare ACO’s serving more than 10 million patients. The success of the Medicare ACO program has led to the growth of similar programs in Medicaid and the private sector.

Essentially, ACO’s are groups of practitioners, hospitals, and other healthcare providers who willingly join together to serve Medicare patients. These groups may initially be unaffiliated, spread across a specific geographic area, and use different electronic health records (EHR) or scheduling systems. That said, the ACO mission and vision is to deliver the smoothest and most cost efficient care to reduce costs, which can be a daunting task for ACO administrators. 

For ACO’s to function effectively, there must be a clear line of communication between the administrators, provider groups, physician practices, and patients; but more importantly, there must be a system for coordinating care—especially patient referral management among ACO’s various providers. And what is one of the best ways to ensure ACO’s can coordinate care to their highest ability and reduce costs? Smart referral and improve quality co-management networks powered by some of the latest technologies, 

The Importance of an ACO Program

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Historically, uncoordinated care due to inefficient access to data and communication systems lead to delays in diagnosis and outpatient treatment, which then lead to unnecessary hospital or clinic readmissions. Not only does this drain patients and practitioners of precious energy and budget resources, but—as an effect of modern technology—it’s also preventable. In 2018 alone, the sum of adult hospital readmissions within a 30-day period was 3.8 million. Across the board, Medicare patients accounted for 60.3%—the highest of all payers at $15,500. This is why the primary purpose of ACO’s is to empower healthcare professionals by coordinating their care services. The results show improved patient experience, lowering costs of care overall, and the ability to enter into a value-based, Medicare Shared Savings Program

The Main Problem

As a health insurance program for Americans over the age of 65. The program was designed to help seniors pay for medical expenses, including doctor visits and hospital stays.

The Medicare program has seen its share of problems over the years with one of the biggest issues being the cost of care. In order to participate in an ACO, physicians must agree to meet certain quality standards and agree to share any savings generated by the ACO with its patients. Many providers refuse to join ACO’s which has limited their ability to provide coordinated care for patients. Additionally, many patients have noted difficulties with communication, specifically in regards to accessing their doctors’ contact information or appointment information through the Medicare website.

In the past, ACO’s have set up care coordination teams to help manage the care of their patients among their various provider groups. But with some ACO’s handling over 1 million patients, this strategy can be ineffective and costly to the ACO. It’s no secret that care coordination services could be more efficient, especially with patient referral management. Often referred to as referral leakage, medical referrals tend to get lost 50% of the time, making it harder on healthcare professionals to deliver the expedient care their patients deserve. The results are missed consultations, confusion, and unnecessary hospital re-admissions or clinic visits. But with many practitioners still using outdated communication methods like fax, it’s easy to understand how referrals and the at-risk patients depending on them slip through the cracks of the healthcare system.

An Example of Reducing Spending with Shared Savings

The social and financial ramifications of this issue are serious. In fact, by 2020, an ACO saved $55 million over a three-year span by switching from old referral systems to a smart referral network. This is because, unlike fax, smart referral system benefits include the ability to track referrals. Practitioners gain peace of mind by gaining visibility into whether referrals arrive from point A to point B safely and quickly. Moreover, smart referral networks enable healthcare providers to communicate easily with one another, including front-desk staff, PCPs, and specialists. 

The Results

Coordinated high quality care systems reduce patient referral leakage, and can also help grow a value-based strategy. These systems can also generate metrics to identify high quality care and low cost in-network providers. The positive outcome of embracing these referral management best practices went above and beyond their expectations. It resulted in major financial shared savings on top of an overall improved organization.

How MedMatch Can Help Your ACO and Medicare Shared Savings Program

With more providers opting to join a Medicare Shared Savings Program such as ACO’s, it is clear that traditional care coordination teams alone are not sufficient to optimize the benefit of such organizations. MedMatch Network is a cloud-based smart referral network that also hosts patient data and facilitates provider-provider and provider-patient communication. The platform uses an electronic referral system, which means every referral can be tracked—closing the referral loop. MedMatch Network integrates with most major EHR, which means you can upload all of your important patient information to one convenient location and it will be available to all care providers. For ACO’s especially, this can be an invaluable tool to keep everyone in your network up-to-date at all times for a seamless co-managing of patients, and reduce medicare spending. 

Predictive analytics is a branch of data science that uses historical data to make predictions about future events. Predictive analytics can be used to estimate the likelihood of an ACO patient incurring a hospital readmission, developing a chronic condition, or needing long-term care. By aggregating and unifying patient data, the MedMatch Network patient database lends itself to the use of predictive analytics to identify high-risk patients and take steps to prevent them from becoming seriously ill. This can save money and improve the quality of care for all ACO patients.

How Does Medicare ACO Share Savings with the Patient

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One of the most important aspects of an ACO is its ability to share savings with patients. As we have seen, MedMatch Network is a valuable tool for optimizing an ACO’s performance. The Network helps care providers communicate effectively with one another, reducing the chance of referral leakage and promoting high-quality care. Additionally, the MedMatch Network can help ACO’s reduce Medicare spending by providing access to patient data and referral analytics.

What does this mean for patients

The MedMatch Network allows patients to have a single point of access to their health information. This means that all of their important medical information—including doctors’ contact information appointments, and lab results—is easily accessible from one location. Additionally, the MedMatch Network provides patients with a unified patient portal where they can easily access their providers in the network. This streamlined system makes it easy for patients to get the high-quality care they need.

In short, the MedMatch Network helps ACO’s optimize their performance while also providing benefits to patients. Through the use of this innovative technology, both ACO’s and patients can achieve greater success in the healthcare market.

The Bottom Line: High Quality Care and Net Shared Savings

Medicare’s (CMS) top six ACO quality measures include: https://www.cms.gov/medicare/medicare-fee-for-service-payment/sharedsavingsprogram/downloads/aco-shared-savings-program-quality-measures.pdf

  • Timely care, appointments, and information;
  • How well your doctors communicate;
  • Patients’ ratings of doctors;
  • Access to specialists;
  • Health outcomes promotion and education; and
  • Shared Savings decision making within ACOs.

MedMatch Network can help an ACO improve all these measures, and so much more. The Network is not only unique in that it can serve the needs of closed networks such as ACOs, but it can also be a system that facilitates transitional care management from other facilities not directly affiliated to the parent ACO.

The MedMatch Network is a proven platform for bringing together a diverse group of providers, establishing clear communication among providers, coordinating referral management, centralizing and providing access to patient data, providing referral analytics for valuable management insight, and establishing a unified patient portal and access to providers in the network. Working hand-in-hand, MedMatch Network and accountable care organization can achieve the ambitious mission to streamline patient care quality and establish new-and-improved best practices for patient care and communication.

Dr. Amos Dare

Dr. Amos Dare

Dr. Amos Dare is the Founder and CEO of MedMatch Network, Inc. Dr. Dare is a Yale school of Medicine trained, physician and neurosurgeon with over 22 years experience in the practice of private and academic medicine.