Physician

The Case for ACOs During COVID-19

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COVID-19 paved the way for rapid telehealth adoption, exposed underlying racial inequity in healthcare, and prompted the Centers for Medicare and Medicaid Services (CMS) to make critical regulatory changes to virtual visit reimbursement. These regulations had far-reaching implications for accountable care organizations (ACOs) and their 2020 financial performance.

Depending on how much downside risk they are willing to accept in a shared savings program, ACOs may be financially liable for their patients’ health outcomes. Value-based care programs were designed to keep patients healthy in order to avoid costly services and procedures, not for a global pandemic that led to countless hospitalizations, emergency room visits, x-rays, and other services for tens of thousands of patients in a period of a few months. This is why 77 percent of ACOs are currently very concerned about their performance in shared savings and 21 percent intend to leave the program if CMS does not generate a solution to insulate them from drastic financial losses.

With all of this financial uncertainty, it is reasonable for providers to question why they should ever join an ACO or value-based care program even after COVID-19. This question is compounded with further questions: how will ACOs and value-based care programs navigate a potential second or third wave of the pandemic? Especially when some shared savings programs require upfront investment, and major healthcare news sources reported the financial strain due to COVID-19?

The bottom line is: COVID-19 only slowed, and will likely encourage, future value-based care participation. The healthcare system will continue to move toward systems and alternative payment models that improve patient outcomes while reducing healthcare expenditures.

That being said, these are just a few of the reasons that providers may want to continue considering an ACO or value-based care program:

ACOs Were a Step Ahead During the Pandemic

Physicians and providers benefit from ACOs far beyond financial rewards. ACOs are networks of like-minded physicians who are focused on delivering high-quality, cost-saving care to their patients. Many ACOs are physician-led, meaning independent practices have the support of other medical experts and a physician has a voice. Depending on the ACO, physicians may join a group of medical professionals from various specialties, backgrounds, health systems, and more.

In addition, ACOs affiliated with managed services organizations (MSO) may have technology, tools, and talent to alleviate the physician’s administrative burdens associated with running an independent practice. MSOs can provide or have access to an electronic health record (EHR) that can support and keep a record of a physician’s care delivery for financial rewards. Some also have data analysts, practice consultants, financial planners, help desks, integrated patient portals, and a myriad of other services available to physicians so they can focus on their patients.

ACOs Are Ahead of the Curve

Unlike clinicians not enrolled in alternative payment models, physicians in ACOs are more likely to engage in preventive health measures to slow the spread of the COVID-19 pandemic. 

Throughout the COVID-19 pandemic, 82 percent of physicians in alternative payment models have reported using care management support to streamline coordination of care. Care management systems can provide preventive care in the place of physicians who are treating the influx of COVID-19 patients, reducing hospital admissions for individuals with chronic conditions, preventable illnesses and injuries, and other non-COVID-19-related medical conditions.

Additionally, clinicians in ACOs are more likely to utilize other value-based care resources available to them, such as triage call centers, remote patient monitoring, and population health data in order to manage patients and prepare for additional COVID-19 outbreaks. ACOs with access to MSOs have financial analysts available to outline the best course of action for their practices for the duration of the pandemic.

Returning to Work

These supplemental value-based care services position physicians in ACOs to help patients seamlessly transition back to their workplaces as businesses reopen. With telehealth services, physicians are available for patients virtually as well as in person. Patients with physicians in ACOs may also have access to care management support and triage call centers for preventive care measures and medical advice. Patients experiencing COVID-19 symptoms can call the triage call center for advice and schedule an appointment with their physician.

Physicians still uncertain about joining an ACO and the challenges of the volume-to-value transition should carefully consider what they are looking for in an ACO. As recommended by the American Medical Association, important factors to consider are the ACO’s financial data, the ACO’s history, and whether or not its administrative services are sufficient. Ultimately, joining an ACO can benefit both the physician and their patients.