What if we could lower the financial burden associated with the top 5% of patients accounting for almost 50% of healthcare costs?1 We believe that such a transformation is achievable through accountable care delivery models like the patient-centered medical home (PCMH), which offers a collaborative, team-based approach with the primary care physician (PCP) at its nexus. One of the most powerful elements in PCMH is that this model financially rewards outcome-based healthcare.
In contrast to the current fee-for-service delivery model, the PCMH model offers financial incentives for PCPs, specialists, and healthcare plans to share their data—thereby avoiding redundancies and identifying gaps in care before they result in hospitalization and emergency room visits. Here in the United States, a 2009 study of a PCMH pilot in Seattle showed that after one year, patient emergency room visits declined by 29%, and hospitalization admissions dropped by 16% versus a non-PCMH control group.2
In this post, we share key care collaboration terminology to help you understand the benefits of access to unified patient information management (UPIM), which supports health plans and provider networks—and helps manage their members with efficiency, efficacy, and quality.
Accountable Care Organization (ACO). As defined by the Centers for Medicare & Medicaid Services (CMS), accountable care organizations are groups of doctors, hospitals, and other healthcare providers who deliver collaborative high-quality patient care. This model aims to ensure that patients, especially the chronically ill, get the right care at the right time—the moments of care. The outcome-based ACO model offers shared savings. CMS recently introduced a number of initiatives for Medicare. Among the most notable is the Medicare Shared Savings Program, which helps Medicare fee-for-service program providers become an ACO.
Care Coordinator. The care coordinator is a new role—and a foundational element of the outcome-based reimbursement model. These healthcare professionals act as patient coaches and advocates to enable the proactive collaborative practice to deliver better preventive and wellness care. Among the duties performed are case management, care collaboration solution use for population management and care delivery, and care coordination for patients admitted to and discharged from care facilities.
Decision Support. Physicians make hundreds of critical decisions each day and need the right information at moments of care to improve clinical outcomes. Decision-support systems institutionalize evidence-based best practices and provide alerts to care coordinators and physicians in the exam room. Decision support can be delivered through clinical alerts via mobile devices and tablets, as well as on a desktop.
Evidence-Based Medicine (EBM). Doctors apply best practices, following established guidelines and regulations, to inform clinical decisions and mitigate risk. Practices that embrace evidence-based medicine systematically use scientific research and medical literature when delivering patient care.
Value-Based Care Delivery. Through this delivery model, healthcare is organized around specific chronic conditions that require integrated care. The goal is to achieve better patient outcomes at lower cost. One excellent example is the Joslin Diabetes Center, whose sole focus is caring for patients suffering with diabetes. The multispecialty, team-based care and patient education programs provide opportunities to examine integrated practice units, early-stage and preventive care, and clinical coordination along the full care cycle. As a result of this focused and collaborative care, the center has been able to improve patient outcomes and lower costs, reducing total annual healthcare costs, on average, by $1,465 per patient.3
Accountable care delivery models will continue to redefine our healthcare landscape. For an in-depth study of care collaboration trends and developments, please access our white paper Partnering with Providers and Health Plans to Bend the Trend.
Senior Director, Corporate Marketing
1 U.S. Department of Health & Human Services, Statistical Brief #354: The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009, Steven B. Cohen, Ph.D. and William Yu, MA; January 2012.
2The Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States, Kevin Grumbach, MD, and Paul Grundy, MD, MPH, November 16, 2010.
3 “Value-Based Health Care Delivery,” a breakout session with Professor Michael E. Porter at The Business Summit, Harvard Business School, October 14, 2008.