In January, the Centers for Medicare and Medicaid Services (CMS) released data showing what many in health care have already recognized – that Accountable Care Organizations (ACOs) are serving a growing patient population in the United States. According to the CMS, 66 new ACOs joined the program and 140 ACOs renewed their participation agreements for 2022, bringing the total number of ACOs in Medicare’s Shared Savings Program to 483.
Before going on, let’s refresh our memories on what exactly an ACO is. According to the CMS, an ACO is “…a group of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.” The goal of this coordinated approach is twofold: first, to ensure that patients receive the right care at the right time, and second to reduce unnecessary spending and prevent medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, they are then able to share in the achieved savings with the payer. In short, the vision for ACOs is to reward providers for better care and smarter spending. And with over 11 million people with Medicare currently receiving care from a provider in an ACO according to the CMS, that vision is well on its way.
Now here’s the question: as ACOs continue to gain in popularity and reach, where do behavioral health care organizations fit in?
The answer, for the benefit of primary care givers, behavioral health providers and patients, is right in the middle of the action.
The Benefits of Behavioral Health ACO Integration for Behavioral Health Providers
Countless surveys and indicators suggest that it is more important than ever before that behavioral health and mental health organizations be well positioned to serve their patient populations. Why not use the well-proven concepts of ACOs to improve, expand and ignite behavioral health care? As a historically fragmented delivery medium, behavioral health providers stand to gain leverage with payors, get attention from providers, and collaborate relative to execution within areas of greatest competency, and coverage of geography by participating in an ACO.
The Benefits of Behavioral Health ACO Integration for Primary and Acute Care Providers
Behavioral health providers aren’t the only ones who stand to benefit from their inclusion in integrated ACOs. Primary care groups that are heavily invested in value-based models are crying out for help in the behavioral health space.
Over the last several years, primary and acute care givers have been forced to recognize that the management of patients’ mental health and wellness has a real effect on clinical outcomes. ACOs are responsible for the full range of health care services for the patients they serve, so having behavioral health, mental health and substance abuse experts at the table is increasingly important.
By wrapping care around the most complex and costly patients, ACOs can improve their quality of care while also reducing costs, which has a direct impact on shared savings opportunities within the ACO.
Forming or Joining an ACO
Behavioral health, substance use treatment facilities and other specialty care providers can and are merging into integrated centers of care as ACOs, both with one another and alongside a range of other health care organizations. In fact, the National Council on Mental Wellbeing has said that “these models will serve as the foundation for healthcare’s future.”
Behavioral health organizations will be well suited to create their positions in this type of patient care as soon as possible, as there is an increasing number of payers and providers investing in ACOs. That said, formation of an ACO should be approached in an organized and methodical manner.
To begin, an organization must decide if it can go it alone or consider who it may partner with in an ACO. Behavioral health provider organizations can approach other health centers, Federally Qualified Health Clinics (FQHCs) and primary care groups and create affiliations for integrated care models to be the basis of their future state ACO. Mental health providers can start this work by identifying their likely partners within their market that could include local hospitals, primary care groups, FQHCs or Rural Health Clinics (RHCs).
Next, before diving into relationships with financial implications, it is vital that behavioral health organizations understand the metrics that will be used to determine success and put processes in place to collect, monitor, and share related data.
Step 1:
The first step in this process is evaluating the technological capabilities that the organization has and identifying gaps that need to be filled. Technology is essential for data collection and data sharing with partners in an ACO.
Step 2:
Once the technology has been addressed, organizations should audit their current data to understand what is available and develop a plan for collecting any missing data. The HEDIS measurements that are established for behavioral health care (under Effectiveness of Care) are a great place to start when sorting data metrics.
Step 3:
Introducing a measurement approach to care is the next step in preparing to enter an ACO. Measurement-based care means incorporating standard assessment tools into the organization’s daily service delivery. In behavioral health care, many of these measurement tools have been a standard part of care for years. Ensuring that the whole organization is using the identified tools in the right places, at the right time and in the right format creates a path to better data.
Once the organization has completed the data-focused steps above, they can confidently move forward and establish relationships with likely partners in an ACO. From there, the medical entities will align on a method to share the data on their common patients, leading hopefully to improved patient care and cost savings for all involved.
The Future of Behavioral Health ACOs
Behavioral health ACOs are needed in today’s health care space and present a unique opportunity to achieve both mission and business goals, but that doesn’t mean their execution is easy. The initial setup, as well as ongoing operations, of an ACO requires financial resources, vision, and a different set of skills than providing clinical services. Organizations interested in following an ACO strategy must have a solid strategic plan, strong operations, and good referral sources. The successful behavioral health organizations of the future will need to navigate both exceptional patient care and a model of value-based care. Our prediction is that integrated behavioral health ACOs will be at the center of this clinical and financial success.
Pattie Clay is a Senior Advisor and Management Consultant, leading MMG’s Behavioral Health Practice. Pattie has more than eighteen years of industry experience and a proven track record as a senior leader in the health system environment. MMG is a national provider of consulting services and back office administrative support to independent and system owned physician practice groups.