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Promoting Accountability in ACOs - Part 3

My earlier blogs, part 1 and part 2 detailed the key concepts influencing the success of ACOs and the need of a change management strategy enforcing stakeholders acceptance of ACOs.

The next important step is to establish a standard clinical process across the ACO which we will discuss in this blog (part 3). The standardization of process is just not restricted to clinical practices but also includes processes such as provider reimbursement, bundled payment, implementation of  payment methods (such as outcome based payment), social media policy to name a few. 

By standardizing the clinical practices and referring to it as a standard practice during diagnosis and other clinical procedures will help establish a central repository of best practices at the ACO level. This will be a dynamic repository which needs to be constantly updated. The ACO needs to establish the performance parameters and goals (such as those mandated by CMS for an ACO) and create its own internal benchmark. The benchmark will help ACO assess its own standing vis-à-vis the industry benchmark and continuously improve upon it. The main purpose behind standardization is to reduce variation in care, primarily by the physicians in an ACO, which will be the key to any successful strategy for improving outcome and lowering costs.

The regulatory compliance requirements have influenced the need for a stronger collaboration among the stakeholders. With the advent of ICD 10 codes, there is a need for a standard way of interpretation, documentation (Clinical) and coding across the ACO. The doctors and coders need to be well trained on these aspects at the ACO level as it will impact the reimbursement. 

The bundled payment proposes to pay the provider organization for the entire episode of care instead of paying each of the individual providers for providing a part of the care. This will suit the ACO way of working as already it has the right coalition established. In such a case, ACO will need a central policy/guideline of its own which will help the providers decide on the services to be bundled and under which situation.

One critical aspect is the availability of an appropriate and accurate analytics tool for the physicians in ACO.  In the current world, with the establishment of EHR, physicians will get all data at the finger tip. But will it ensure the physicians draw the accurate conclusion out of the data? The physicians need to spend adequate time and do the adequate synthesis of data at the beginning of the diagnosis. In a setup like ACO, the required collaboration between different departments or care providers can be facilitated to achieve this objective. The accuracy of the data synthesis process will help remove the unnecessary services, procedures, medications which will ultimately improve outcome and reduce the cost. 

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