Accountable care organizations are becoming increasingly prevalent in the health care marketplace, but many providers are still determining how to become involved. Although the path to ACO readiness is still being defined, one thing is certain: the success of an ACO will depend on its effectiveness in becoming a vertically integrated delivery system.
Eligibility to participate in shared savings programs requires a group of providers to coordinate delivery of care for a defined population in a way that improves quality and efficiency. There are many acceptable ACO organizational models, but physician involvement is integral to ensure quality and cost benchmarks are met.
Primary care medical homes coordinate communication among specialists, hospitals and pharmacies in a vertically distributed care model. When this key role in an ACO is filled at the primary care level, physicians are able to provide a more comprehensive and convenient service that leads to faster, more qualified referrals to specialists, improved database management through shared test results and decreased re-admissions for preventable problems.
Through the right network of providers, an ancillary strategy such as in-office diagnostic testing can further enhance an organization’s value and ability to provide comprehensive services. Offering preventative care and diagnostic screening at the primary care physician level is more effective than screening at the specialist or hospital level; not only can these services be provided at a lower cost, but this allows the physician access to complete data needed to truly assess a patient’s health.
Many accountable care organizations are being created through a partnership between hospital systems and payers. Having an ancillary strategy within the primary care practices that are owned and/or operated by the hospital system provides a distributed model of care throughout the system. It also helps to promote vertical integration, with the expectation of keeping the patient within the system for any additional care that may be needed. Outsourcing the ancillary testing means generating passive revenue for the system without the need for any capital expenditure—all while being more convenient for the patient.
Effective ACOs must provide excellent care to patients who regularly visit a physician, but must also provide the highest quality care possible for patients who rarely see their healthcare providers. Primary care physicians who offer in-office diagnostic testing with advanced screening equipment make it more convenient for the patient to have necessary testing done right when it is needed. Not only does this increase patient compliance, it also improves efficiency and clinical outcomes at a lower cost.
Using an ancillary strategy as a mechanism to provide more services to patients at the primary care level is a growing trend among physicians. Physicians are not only being more selective with their payer mix, they’re also looking for ways to create additional revenue streams, according to Medscape’s 2013 Physician Compensation Report. In an effort to improve their bottom line, 19 percent of respondents have begun offering ancillary services to create more income opportunities for their practice.
The future of healthcare belongs to organizations that can provide higher quality services more efficiently and at a lower cost. As providers begin to form new ACOs and existing ACOs continue to develop and refine their networks, ancillary strategies offer one solution to adapt to the ever-changing healthcare environment.
Nate Nelson is a co-founder and partner in Frontera, a mobile diagnostic testing company based in Irving.