5 CARE COORDINATION STRATEGIES FOR MEDICARE ACO SUCCESS

5 CARE COORDINATION STRATEGIES FOR MEDICARE ACO SUCCESS

As a part of the value-based care, Accountable Service Organizations (ACOs) under the Medicare Shared Savings Program (MSSP) have devised several strategies to slash Medicare expenditures while enhancing healthcare outcomes.

These strategies include raising cost awareness among ACO practitioners, involving recipients in self-care, and managing participants with complex and expensive care requirements to optimize care delivery.

Other effective ACO strategies include:    

Lowering unnecessary emergency room visits.

Minimizing expenses, boosting inpatient care.

Tackling social determinants of health (SDoH) needs.

Using tools to optimize exchange of information among providers.

Centers for Medicare & Medicaid Services (CMS) hopes to educate the people about ACO strategies for providing value-based care through its

toolkits. It is offering actionable ideas to present and potential ACOs to help them enhance or begin operations for risk adjustment programs.

A new CMS toolkit highlights five advanced care coordination strategies that have assisted Medicare ACOs in finding success via shared savings and care coordination for beneficiaries who: 1. GET EMERGENCY CARE IN THE E MERGENCY R OOM (ER)

The emergency department is one of the most expensive medical facilities, and people frequently come there unnecessarily. As a result, many ACOs are focusing on ED reform to meet their shared savings targets. ACOs arrange in-person discussions with hospital management and coordinators to develop a collaborative environment. ACOs also incorporate care program managers into the emergency department to enable quick care coordination between ED practitioners and PCPs. 2. NEED CARE IN A SKILLED NURSING FACILITY (SNF)

To improve care collaboration with SNFs, ACOs propose developing networks of high-performing SNFs, connecting preferred SNFs, and assigning committed staff to facilitate care transitions.

ACOs also recommend creating networks of recommended SNFs that regularly deliver high-quality care based on available information. To encourage ongoing quality improvement in the provision of Skilled Nursing Care by forming workgroups and collaboratives to facilitate peer-to-peer learning among SNFs. 3. HAVE LATELY BEEN DISCHARGED FROM A HOSPITAL OR ER

Schedule home visits to carry functional, social, and environmental assessments for beneficiaries who received inpatient treatment no more than five days after discharge. These visits help in reviewing discharge instructions with the recipient and providers.

4. ARE DIAGNOSED WITH A CHRONIC DISEASE

ACOs employ a collaborative medication management strategy that includes pharmacists, practitioners, and care coordinators to assist beneficiaries in agreeing to stressful prescription schedules. This promotes effective self-care techniques.

5. HAVE HEALTH-RELATED CONDITIONS THAT ARE INFLUENCED BY SOCIAL DETERMINANTS OF HEALTH (SDOH)

ACOs simplify the process of identifying and addressing beneficiaries' SDoH needs. ACOs are developing digital resources that allow care coordinators, social workers, and providers to discover community members that tackle SDoH and make effective referrals.