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Medical Home... Medical Neighborhood... Accountable Care Organizations... What Does This All Mean to You and Your Practice?

Edited by Steve Selbst and Deanna Woolf, Quill Healthcare Executive Consultants

In 2015, there is tremendous pressure for change in the clinical practice of medicine coming from all quarters. The Affordable Care Act (ACA) has stimulated an industry-wide discussion about how health care should be organized and financed. Employers, health plans and governmental agencies are piloting innovative models for payment to rein in health care cost escalation. We are seeing consolidation of hospitals and office practices into larger organizations that can manage risk-based contracts or capitated agreements. The ACA established the structure and regulations for Accountable Care Organizations and set the stage for payment reform, which will move away from fee-for-service and toward value-based payment.

What can providers do to get ready for this change and position the practice to be successful in the future? Although a lot of the focus has been on primary care, sub-specialty practices, community service providers and hospitals also need to collaborate to provide seamless integrated care to those in need. We suggest that you focus on a few high-leverage changes in culture and workflow that will serve you well in the new practice environment.

  1. Team-based care allows nurses, pharmacists, social workers, health coaches and other professionals to act in concert to assist patients in managing their chronic conditions. Time with the physician can then focus on complex issues and development of a care plan. Care team members provide outreach and follow up for high-risk patients between visits.
  2. Health information technology must be used to optimize connectivity, knowledge management, communication, education and outreach to patients. Electronic medical records with embedded point-of-care registries are essential for managing patients with chronic conditions or complex treatment regimens.
  3. Risk stratified care management and care coordination assure that complex patients get the evidence-based care they need when they need it and do not fall through the cracks.
  4. Patient/family/caregiver engagement enhances the care and clinical outcomes for patients. Patient self-management support — including motivational interviewing, shared goal setting, home monitoring and between visits follow up — improves patient satisfaction and well-being.
  5. Collaboration within the medical neighborhood reduces waste and fragmentation, fostering a shared sense of responsibility for service, cost and quality.
  6. Clinical, financial and information technology integration will be required to be successful in accountable care organizations, Medicare Advantage plans and the value-based purchasing environment.