September 15, 2015 Leave a comment
When employers think about population health, they are thinking about the health of their workforce and their retirees. Employers want their workforce and their retirees to become and remain healthy. For large, self-funded employers this is about the bottom line and reducing health care costs, but more important than that, it’s about employee/retiree health outcomes, satisfaction and employee productivity.
Accountable Care Organizations (ACOs) are one of the promising new models of health care delivery that seeks to deliver better quality care at lower costs. ACOs can be designed to improve the quality of care, increase patient satisfaction, and lower the cost of care by aligning incentives and connecting the care provided by hospitals, medical groups, and health plans to work together to decrease fragmented care. So what are large employers looking for from ACOs?
First and foremost, employers want an ACO to consider the care of “the whole person.” They recognize that not all ACOs are alike and that they have different capabilities. They expect ACOs to meet all the care needs of their employees, including behavioral health. To do this, the ACO needs a wide variety of service providers that deliver a holistic menu of care. For example, if the patient has a psycho-social issue, the ACO should have a social worker who can address that issue. If the patient needs to lose weight to help with her diabetes, she should have access to a dietician to work on changing her eating habits.
Second, employers want their ACOs to offer integrated care. Fragmented care is not only challenging for patients to navigate– it is not clinically optimal. Primary care providers, behavioral health providers, pharmacy staff and specialists should work together, share information with each other, and have shared incentives for the same goal: the patient’s best interest.
Employers also want their ACOs to be able to identify the highest-risk patients and target them for special intervention. The greatest savings come from identifying the sickest patients and keeping them out of the hospital. The ACO needs to be able to identify these individuals and intervene before episodes escalate out of control. Some early employers in this space have seen great success with this targeted intervention, which is now a vital component of both employer-driven and health plan-driven ACO products.
ACOs also need to be able to support“smart” benefit design features designed by employers to engage employees in a partnership for value based healthcare. This means ACOs should have programs and policies in place that align with the employer’s goals of promoting patients’ access high quality care, and efficient use of care. Appropriate utilization of high priced procedures, integration of step therapies, and shared decision-making have been shown to reduce cost and improve outcomes.
Finally, employers want their ACOs to embody quality improvement and payment reform. For decades, employers have been concerned about the variance inquality of care of our health care system. They know they spend too much for care that is too often unneeded, unsafe, and of poor quality. ACOs should be committed to quality improvement, and capture data so they can track their quality outcomes including patient reported outcomes. They should work with their partners implement new forms of payment that rewards for good quality, and that does not pay for waste and efficiency.
Lauren Vela, MBA
Senior Director of Member Value, Pacific Business Group on Health
As Senior Director of Member Value, Lauren works directly with the large purchaser members of PBGH to facilitate collaboration and to support their purchaser-driven initiatives impacting healthcare delivery in the US. To that end, Lauren manages the processes of translating PBGH’s ground-breaking work in transparency and accountability into workable solutions for PBGH member organizations.
Prior to this role, Lauren was the Executive Director of the Silicon Valley Employers Forum (SVEF), a coalition of high tech employers that benchmark benefit designs and collaborate for improvement. During her SVEF tenure, Lauren systematized the group’s benchmarking practices and served as a facilitator and strategist for their joint projects with regard to both US-based and international employee benefit programs.
Prior to the SVEF role, Lauren enjoyed a twelve-year tenure with PBGH serving in three distinct areas; multi-stakeholder health information exchange, provider group organization improvement, and employer value-based purchasing. To this day, SVEF and PBGH maintain a strategic alliance and Ms. Vela works closely with purchaser members of both groups.