July 21, 2024
Accountable Care Solutions

Collaborative Models Transforming Healthcare Delivery

Rising Costs Drive Search for Accountable Care Solutions

Growing healthcare costs in the U.S. have made the existing fee-for-service payment model unsustainable. Each year, costs rise while millions remain uninsured or underinsured. In response, providers and payers have developed innovative accountable care models focused on quality, care coordination, and cost-savings. By establishing collaborative networks and shared accountability, these solutions aim to improve outcomes while bending the cost curve.

Alternative Payment Models Reward Accountable Care Solutions

Traditional fee-for-service rewards volume over value by paying providers for each test and procedure. This creates incentives to perform more services whether needed or not, driving up costs. Accountable Care Solutions (ACOs) and similar models shift reimbursement to population-based payments that reward keeping patients healthy. Providers are accountable for the total cost and quality of care for their patient population over a year or longer. Those who deliver high-quality care at a lower cost receive to share in the savings. This spurs collaboration between primary care, specialists, hospitals, and other care teams.

Data and Technology Aid Coordination Across Settings

Care under these models is coordinated through a patient’s primary care provider and broader care team. Electronic health records and care management tools help providers track patients, identify gaps in care, and proactively address needs—especially for those with chronic illnesses. Community health workers and telehealth expand access to care in patients’ homes and neighborhoods. Payers also provide data and analytics to help providers understand their patient population’s risks and needs. This supports proactive, personalized care plans addressing medical and social determinants of health.

Cost-Savings Stem from Preventing Expensive Events

Rather than payment per visit or procedure, population-based budgets incentivize keeping patients healthy and out of the hospital or emergency room when possible. Conditions are better managed in lower-acuity, lower-cost settings through prevention, chronic care management, and addressing social needs that impact health. When inpatient or specialty care is needed,Utilizing evidence-based guidelines helps ensure appropriate and efficient resource use. The result is fewer avoidable or exacerbated illnesses, readmissions, and other costly events over the long-run. Savings generated can then be reinvested in strengthening primary care and supporting services.

Quality Metrics Ensure Patient-Centered Care Achieves Targets

Quality of care remains paramount under these models. Providers are measured on clinical quality metrics such as controlling hypertension and diabetes, cancer screening rates, patient experience scores, and other standardized metrics. Those who succeed in delivering high-quality, evidence-based care while meeting cost and utilization targets receive payments based on overall population health improvements rather than billable services. Funding is tied to performance to guarantee accountability, with multi-year arrangements allowing time for culture change and investments in infrastructure.

Collaboration Crucial to Address Social and Behavioral Health

Coordinated, patient-centered care depends upon diverse providers working as an integrated team. Behavioral health, social services, community organizations, and others play key roles supporting clinical care, especially for those facing social barriers. Integrated primary care clinics co-locate behavioral health specialists and social workers. Community health workers connect patients to social services addressing food, housing, transportation and other non-clinical needs. Partnerships help providers identify and remove obstacles inhibiting care plan adherence and outcomes. Cross-sector data sharing supports a comprehensive understanding of each individual served.

Early Adoption Shows Promising Savings and Quality Gains

While still a relatively new approach, preliminary analysis reveals accountable care models achieving cost-savings while maintaining or improving quality of care. An annual savings of hundreds to thousands per patient adds up significantly across a population. However, upfront investments in care management infrastructure and sustained engagement are needed to fully integrate services and support long-term cultural shifts.

continued research and refinement will enhance these collaborative, value-based models as they spread nationwide. Overall, the early results suggest these coordinated, population-based solutions hold potential for sustainably improving Americans’ health outcomes and access to care.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it