How ACOs align perfectly
with COPD treatment goals

 

Learn how ACOs create amazing opportunities to support
COPD treatment goals and elevate value-based care.

With roughly 24 million chronic obstructive pulmonary disease (COPD) patients in the United States, COPD care demands incredible spending—nearly $36 billion a year.1 Yet as healthcare evolves, COPD care teams are facing another incredible demand—increasing the quality of care while lowering the cost of it. This leaves organizations searching for new solutions to these newfound problems. 

 

So what can your team do to combat increasing costs without sacrificing quality care for COPD patients? Joining an ACO may be the solution.

 

What is an ACO?

 

An ACO, or accountable care organization, is a group of multidisciplinary healthcare professionals who work together to coordinate care for Medicare patients. Their purpose is to improve quality and reduce costs.2

An ACO can comprise hospital physicians, nurses, home healthcare workers, private-practice physicians, insurance companies, laboratorians, and more. This dedicated team is responsible for a patient’s entire continuum of care, providing a longitudinal approach rather than episodic. This approach works to proactively keep patients healthy, at home, and out of the hospital.

By working together and coordinating efforts, ACOs enable institutions to better predict, analyze, target, and treat entire populations.

Contributors

Becky Anderson, RRT

Manager, Respiratory

Care Services,

Sanford Medical Center

Jill Ohar, MD, FCCP

Professor of Internal Medicine, Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest University School of Medicine; Director of Clinical Operations, Wake Forest University Baptist Medical Center.

Les Duncan

Director of Operations, Highmark-
Community and Health Services

On positively impacting patients and institutions

The ACO model is so important because people with chronic disease should be living well in their homes, they shouldn’t be accessing hospital services, which is the most expensive component of healthcare.”

—Jill Ohar, MD, FCCP
Professor of Internal Medicine, Pulmonary, Critical Care, Allergy,
and Immunological Diseases
Wake Forest University School of Medicine
Director of Clinical Operations
Wake Forest University Baptist Medical Center

How do ACOs work?

 

ACOs are different from HMOs, or health maintenance organizations, in that patients can visit any healthcare facility, whether or not it is part of the ACO. However, all organizations within the ACO are still accountable for that patient’s wellbeing.

 

As such, keeping track of each patient’s care is crucial to the success of an ACO. Medicare helps by:

 

• Assigning all patients a unique tax identification number

• Tracking numbers to know when patients submit claims

• Reporting claims data back to the ACO

 

Since many ACOs are responsible for tens of thousands of patients, tracking these ID numbers streamlines monitoring and care management.

The main benefits of an ACO

On making the most of the ACO opportunity

—Les Duncan, Director of Operations

Highmark–Community and Health Services

ACOs—maximizing value in COPD care

 

Not only are ACOs proving to be valuable for the healthcare industry as a whole, they are creating vital advantages in managing COPD. See how our thought leaders are breaking down the benefits across the care journey.

Earlier identification

 

As ACOs support broader datasets across populations, they can be a huge driver in identifying patients earlier. This empowers more effective care. For different individuals, it can mean better maintenance of wellness or management of chronic disease. But for all patients, it can help contain costs down the road.

On the benefits of ACO data and analytics

—Les Duncan, Director of Operations

Highmark–Community and Health Services

Stratifying patients by risk

Once patients are identified, ACOs give physicians the ability to stratify them by risk and implement best practices accordingly.

On the value of patient stratification

—Les Duncan, Director of Operations

Highmark–Community and Health Services

On the vision of preventative care

We want a more proactive approach in population health management. We need to get to a point where we invest more in preventative and well care so we are avoiding the index admissions”

—Becky Anderson, RRT

Respiratory Care Services Sanford Medical Center

Get them home, keep them home

COPD care teams can no longer afford to only focus on getting patients healthy and home. They now need to ensure patients stay well enough to avoid coming back. This requires more than coordination. It requires a major investment in home healthcare, which is perfectly in line with the ACO model.

 

According to Les Duncan, 50% of the cost of an ACO is inpatient admissions and 25% is post-acute care. This post-acute care includes skilled nursing facilities, home health, and inpatient rehab facilities. In an ACO setting, you want to see this high grade of spending in post-acute care, as it is a big-picture investment in reducing the risk of far costlier admissions.

The data collected through an ACO can help you determine the most efficient place and time to provide care.

 

  • • Home contact: Whether a care manager, nurse, or other care team member, this intermediary support network can work with patients to de-escalate problems, help them learn to self-manage at home, and avoid going to the emergency department (ED)
  •  
  • • Extended team: Increasing your investment in social workers, nurse care coordinators, and respiratory therapists within your ACO can help minimize the cost burden of hospital visits and provide patients with the care they need in the home setting

On the cost savings of post-acute care

—Les Duncan, Director of Operations

Highmark–Community and Health Services

On reducing ED visits with care managers

—Les Duncan, Director of Operations

Highmark–Community and Health Services

ACOs and you

 

They say teamwork makes the dream work—and this certainly applies with ACOs. So, as you evaluate your COPD treatment goals, consider this: How could an ACO be beneficial to your institution and patients?

On changing the trajectory of healthcare

—Jill Ohar, MD, FCCP

Professor of Internal Medicine
Pulmonary, Critical Care, Allergy, and Immunological Diseases
Wake Forest University School of Medicine
Director of Clinical Operations
Wake Forest University Baptist Medical Center
Sources: 1. Ford ES, Murphy LB, Khavjou O, Giles WH, Holt JB, Croft JB. Total and state-specific medical and absenteeism costs of COPD among adults aged ≥18 years in the United States for 2010 and projections through 2020. Chest. 2015;147(1):31-45. 2. Accountable Care Organizations (ACO). Centers for Medicare & Medicaid Services Web site. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/. Updated January 6, 2015. Accessed October 3, 2016. 3. Davis MA, Nallamothu BK, Banerjee M, Bynum JP. Identification of four unique spending patterns among older adults in the last year of life challenges standard assumptions. Health Aff (Millwood). 2016;35(7):1316-1323. 4. Powers J. Lung Function Affected by a Single COPD Exacerbation. European Respiratory Society: Abstract 194OC. September 2, 2012. 5. Blanchette CM, Gross NJ, Altman P. Rising costs of COPD and the potential for maintenance therapy to slow the trend. Am Health Drug Benefits. 2014;7(2):98-106.
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Further reading

COPD insider

Insider guide: Building your COPD executive care team

 

This infographic details how to build your multidisciplinary executive care team and what contribution you can expect from each team member.

Identifying COPD patients: The first step to quality outcomes

 

Learn how to identify patients with COPD sooner by proactively focusing on additional risk factors, special populations, and more.

How ACOs align perfectly with COPD treatment goals

 

What exactly is an ACO and how can it impact your practice? Get ready for a very moving discussion on how itzlready redefining value-based care.

All content on this site is for informational and educational purposes only and is not a substitute for medical advice of your doctor or other health care professional. Always seek the advice of your physician or other health care provider with any questions you may have about any medical condition.  Refer to the Terms of Use for additional information.