As ACOs continue to gain traction and shift focus to cost-efficient quality care, three emerging roles are proving to be essential for maximizing performance. If you’ve recently established or joined an ACO, consider how these new jobs can help set your organization up for success
Now more than ever, it’s necessary to eliminate fragmented care and focus on the bigger picture. This is fundamental to achieving better patient outcomes at the lowest cost. Without a dedicated person who can break down silos and oversee the entire continuum of patient care, it’s easy for details to slip through the cracks..
Care coordinators typically have a nursing background or a broad foundation of medical knowledge. They help patients navigate the complicated healthcare system to assure the delivery of optimal care at every touchpoint. This role not only supports higher quality care for patients, but also cost-efficient care for providers.
A few of the key duties care coordinators are responsible for include educating patients about their conditions, sending patients to the right departments at the right time, and helping coordinate appointments. They also work with Medicare and other payers, and ensure that patient data get into the right hands.
A care coordinator maintains a patient-centric approach within your organization through increased patient contact, continual monitoring and a comprehensive view of care. For example, this bird’s-eye view might allow care coordinators to direct patients away from costly emergency room visits when a different department might be able to treat the problem at a much lower price.
Establishing and running an ACO requires extensive planning, coordination and ongoing leadership. To ensure success within the organization, it’s critical to have a dedicated person overseeing resource management, daily business operations and logistics.
An ACO administrator manages the overall organization from a business angle, allowing healthcare providers to keep their focus on the patients. Among other functions, ACO administrators provide direction and support for daily operations, develop and manage budgets, and manage and coordinate with cross-functional teams. They also lead large-scale organizational change in the areas of payment, technology, workforce and infrastructure. They may negotiate payer and vendor contracts, and develop relationships with external partners.
By bringing a strong business perspective to the healthcare-focused environment, ACO administrators not only ensure smooth operation within the organization, but also cultivate synergy and collaboration among teams and vendors to improve efforts and outcomes.
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Labs have the value of historical, longitudinal data. So if an ACO has the capability to aggregate the data, then an ACO is now taking a risk and is now responsible for a population. So yesterday they were “fee for service,” so they only cared about what patient came in their door.
Now they have a baseline of information that they can help risk stratify those patients that may have had a history. And that data could, not just only the lab results, but other disparate data, can connect those dots of patients that are the low end and the high end and those that maybe just need to be followed or monitored, or maybe might go out and say, okay, we need to do a health risk assessment.
These are patients we think we need to come in, have some more information. Could be a paper or health risk assessment where they would complete and get information. But lab results really are a very big precursor for allowing insurance companies and ACOs who are absorbing risk to better know who's in their cashmen.
A major benefit of establishing an ACO is the incentive to collect data that can be used to manage populations and support accountability for outcomes. However, data is useless without someone who can accurately analyze its findings.
Medical analytic specialists interpret data collected within an ACO (such as claims and readmissions, payer reports and quality reports) to identify current trends and opportunities. They identify emerging trends and patterns in order to recognize opportunities to improve quality, outcomes or costs, prepare detailed reports of key findings and deliver presentations to stakeholders.
By interpreting data and synthesizing it into insights, medical analysts give stakeholders and key decisionmakers the ammunition they need to drive care transformation within the organization.