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Practical Patient-Centered Care Strategies Key for ACO Success

With more Medicare payments tied to valued-based reimbursement and ACOs, providers need practical patient-centered care strategies to improve outcomes.

As the healthcare industry continues to embrace value-based reimbursement models, accountable care organizations need a strong grip on practical patient-centered care strategies in order to remain competitive, according to a viewpoint published in the American Journal of Managed Care.

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However, understanding and implementing patient-centered care strategies can be challenging because they are often poorly-defined and very vague.

“Patient-centered care (PCC) is perhaps one of the most-used and least-understood terms in healthcare today,” the authors said.

“Although it was proclaimed a core health system aim in a 2001 Institute of Medicine (IOM) report, the term too often involves a series of aspirational statements about respect for patient values that give rise to widely different interpretations that are more ‘turn of phrase’ than ‘term of art.’”

While the term patient-centered care can be somewhat ambiguous, healthcare providers across the country are facing calls to deliver better person-first care. Between regulatory requirements for more patient engagement efforts and cost-sharing set-ups such as ACOs, providers need a strong grip on the concept in order to remain competitive in the industry.

ACOs call for several protocols to ensure strong patient-centeredness. For example, ACOs require a beneficiary of the ACO to sit on the advisory board.

ACOs also face an onslaught of “aspirational” requirements, the researchers said, such as “patient-centeredness integrated into practice.” These aspirational requirements do little to direct ACOs in better patient care, highlighting a need for more concrete and actionable requirements from policymakers.

To develop a better understanding of patient-centered care, as well as determine best practices for patient-centered care in ACOs, the researchers conducted qualitative interviews with 15 leading ACOs across the country. These interviews revealed a disconnect between practical patient engagement efforts and those called for by policymakers.

For example, the Institute of Medicine called for focus on patient needs and preferences, helping to drive care that patients desired and that met their medical and physical needs.

In contrast, the majority of ACOs focus on building a strong care team of which the patient is a prominent member.

“The ACOs we spoke with had a 3-pronged practical approach of: 1) patients as partners, 2) proactive customer-service orientation, and 3) care coordination with a whole-person approach,” the researchers reported.

Additionally, ACO leaders emphasized that patient-centered care strategies cannot be one-size-fits-all, despite the fact that many policies and regulations treat them as such.

“Organizational context is important,” the team reported. “Physicians acting alone will likely struggle to satisfy the PCC goals that are now routinely included in many value-based payment models. Organizational efforts to establish and enable such change are crucial.”

Case in point, larger ACOs were able to leverage health technology to intervene with high-risk patients. Using EHR data analytics, large ACOs could identify chronically ill patients and cater their care strategies accordingly.

Smaller practices needed to enlist their office staff comb through some data and identify high-needs patients themselves.

Larger ACOs also had the resources to create practice-wide care improvement goals and train individual leaders in attaining those goals through targeted patient engagement strategies.

“Some ACOs trained physicians in motivational interviewing, and others directly measured patients’ motivation through the Patient Activation Measure, using that information to tailor messaging,” the researchers explained.

“Overall, turning a provider-centered organization into a patient-centered one means linking high-level leadership and goal-setting to practical actions, cumulatively meant to ensure that patient-centeredness would take root.”

According to the researchers, policymakers need to take a more practical approach to creating patient-centered care requirements, especially as the government calls for more Medicare reimbursements to come from ACOs going forward.

“The first step is for governmental and private payers to stop constantly piling new requirements upon the old,” the authors advised. “Then, together, payers and providers need to examine far more closely what works in the frontlines of care.”

And perhaps most critically, the authors noted, policymakers should consult with leading ACOs to determine how they implement quality patient-centered care in practice. This will result in a set of benchmarks that are more feasible for other ACOs to meet and will boost patient care.

“We believe learning from the approach of successful ACOs—having a framework of patients as partners, having a proactive customer-service orientation, and utilizing care coordination with a whole-person orientation—can guide the healthcare system as it moves ‘from volume to value,’” the authors concluded.

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