Accountable care: Redefining value and success in healthcare


Delivering value-based, integrated care for better outcome.

Today’s healthcare industry is undergoing a major change: The transformation to an accountable care model. Governmental, payer and industry bodies have all proposed healthcare quality measures designed to improve patient outcomes. Governments, payers and providers are evaluating these proposals in an attempt to determine which measures will be adopted.

The move to accountable care will replace the existing fee-for-service payment model with one based on the delivery of value-based, integrated care. To achieve and maintain a sustainable healthcare system, payers and providers will have to evolve their thinking and processes to adapt to this new model.

Some healthcare organizations have already begun to differentiate themselves by building new products and services, forming new partnerships and reorganizing to address the coming changes. However, most payers and providers are still struggling to define the characteristics of an accountable care organization and how to adjust to new requirements.

Everyone involved in healthcare delivery will need to become focused on and accountable for the care of individuals. This change will challenge the ecosystem and the result has the potential to significantly improve the healthcare delivery system.

How accountable care changes healthcare delivery

The transformation to accountable care models will blur the lines between payers and providers, and in some cases they will disappear. Organizations that continue to think and act separately will most likely end up losers. The winners will be those who face the change head on, think differently and proactively collaborate with others to improve care and efficiencies.

 Payers will become more closely integrated with care delivery organizations. Some will work with providers to open jointly-owned clinics. Most payers are expected to reduce the number of in-network providers and include only those organizations focused on offering higher quality care and achieving better outcomes.

Providers will see ongoing industry consolidation resulting in the alignment of risk sharing and value-based payment schemes. In addition, provider organizations will build fully integrated, sustainable healthcare systems that enable efficient and flexible delivery of patient services. These new systems will enable providers to capture revenue across the entire spectrum of care; from the hospital, to the doctor’s office, clinic, home and long-term care. Hospitals, physicians, and other caregivers will be financially motivated to collaborate, and reduce waste and redundancy.

Customized health benefits that support the specific needs of individuals will become more common. For example, if a government-funded healthcare patient has a chronic disease and doesn’t drive, they will either receive care at home or transportation services to get them to the doctor, even if transportation services are not a standard government-funded healthcare benefit. For this person, access to transportation or at-home treatment is a necessity for ensuring that proper care is received and will help them become a healthier and less costly patient who requires fewer hospital stays.

The transformation to accountable care won’t happen overnight. It will occur in phases. To be ahead of the game, payers and providers should already be proactively planning and executing changes that address new requirements.

Achieving success with the new accountable care model

Organizations that want to make a successful transition to accountable care will make fundamental changes in how they do business and provide care. In most cases, those that end up on top will have taken most, if not all, of the following actions:

1. Establish a strategy and roadmap for change

To realize operational excellence and a successful transformation, organizations need to determine now how they want to evolve to meet the changing model — and which internal changes they need to make and what partnerships they need to form to ensure success. Once an organization decides where it wants to play in the future, it should be fairly obvious what actions will be required to get there.

2. Form new partnerships

Payers and providers will organize in new ways and will collaborate to improve the health of the population in many different ways. Organizations that group together to prevent errors, improve outcomes and reduce costs will increase their effectiveness and emerge as winners. Those who refuse to change and insist on protecting old structures will be left behind.

3. Embrace ICD-10 

The new disease classification codes introduced in ICD-10 mark the biggest change in healthcare coding in decades. An important building block to enable many future changes, ICD-10 includes many new diagnoses and treatment codes and will be the basis for care moving forward. Organizations that build an understanding of ICD-10 now, and implement care models based on it, will benefit, as will their patients.

4. Adopt smart mobile technologies

Recent advancements are enabling the use of smarter, connected mobile technologies to supply or monitor crucial information for patients with specific illnesses. These technologies can significantly improve diagnosis, treatment and condition management while reducing costs. Potential uses include reporting the time and place that asthmatics use inhalers, or enabling automatic submission of blood and weight readings of diabetics, and informing patients to take medication or seek treatment when certain conditions exist.

5. Expand patient communication methods

The adoption of social media, text messaging and other new communication methods will help organizations more easily reach and interact with younger patients. For example, if a patient under 30 is trying to quit smoking and has said that the hardest time of the day to deal with their craving is right after dinner, then you might send them a text at that time to wish them good luck with their program.

6.    Incorporate new technologies and utilize more data

Implementing and utilizing new technologies that increase access and transform data into useful information will improve and customize care. These technologies may include electronic medical records, predictive analytics, data modeling, health information exchanges, health benefits exchanges, remote monitoring, mobile monitoring and reporting, social media and alternative communications.

The future of accountable care is here

The transition to accountable care models has begun. Most healthcare organizations realize they can’t sustain their current fee-for-service model and know they will need to change. Some payer and provider organizations are already forming partnerships and collaborating in new ways to increase value and improve patient outcomes.

Organizations are implementing new technologies that enable information to be accessed, exchanged and analyzed, and patients to be monitored in new and different ways that have never before existed. The true benefit of these technologies is not in the quantity of data they provide, but in how they transform data into useful information that can make a difference, and improve value and care.

Accountable care will redefine value and success in the healthcare world as we know it. Organizations that don’t respond to the inevitable changes necessary for more sustainable accountable care delivery models may not survive.