Accountable Care Organizations (ACOs) were created in 2011 by the U.S. Department of Health and Human Services to combat rising healthcare costs and to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

The program has grown dramatically since then:

• 32 ACOs in 2011
• 483 ACOs in 2022

More than 11 million people with Medicare in 49 states were served by shared savings program ACOs in 2022.

ACOs are an essential innovation for moving the healthcare system away from being paid for providing services (“fee-for-service model”) and towards being rewarded for keeping people healthy by delivering value and good outcomes. ACOs are held accountable for spending and quality measures, including outcomes and patient experience – and they support integrated care by ensuring that their healthcare providers work as a team.

While the program has been most successful for the general population, there are still opportunities to improve care for those requiring more complex levels of care—especially the millions of people in the U.S. who experience mental illness each year.

The Emerging Behavioral Health Crisis

According to the Kaiser Family Foundation, more than 30% of adults in the United States reported symptoms of behavioral health and substance use disorders in 2021 – roughly a threefold increase from pre-COVID statistics. That’s more than 100 million people. Unfortunately, many of them aren’t getting the care they need. And, when they do, the costs to the healthcare system are staggering.

 Patients with Behavioral Health Issues:

• Are 8X more likely to use emergency rooms
• Have 3.5X higher health care costs
• Are only diagnosed 20% of the time
• Only 5% receive treatment

This behavioral health emergency isn’t happening in a vacuum. A steep decline in general physical health due to the COVID-19 pandemic is directly correlated. Approximately 36% of patients suffering from a chronic health condition have co-occurring behavioral health challenges. And patients presenting in emergency rooms with an initial behavioral health crisis also have a substantially increased risk of suicide and other mortality during the following year.

People are dying due to systemic failure resulting in a lack of access to care. It doesn’t have to be this way!

A Better ACO Model: Integrated Systems of Care

In 2017, a group of ambulatory outpatient providers launched an ACO that included behavioral health providers to improve access and care coordination. This highly collaborative and data-driven model of care would improve disease detection, accelerate access to the proper care provider, and improve patient engagement – keeping patients out of emergency rooms and reducing readmissions. The new models, called Integrated Systems of Care (ISOCs), brought together a diverse network of local providers and community resources to work effectively with the most complex patients. These networks include:

• Real-time, data-derived alerts on patient needs, risks, trends, and gaps in care
• Mitigation of social and medical obstacles to treatment compliance
• Shared care coordination, telehealth, and patient engagement technologies
• Grand Rounds PCP/Psychiatric collaboration to expand psychopharmacology resources
• Standardized and transparent transitional care procedures matched to patient need

The Results Speak for Themselves

With the adoption of ISOCs, participating providers and provider networks have seen significant changes:

• 75% reduction in inpatient bed days
• 70% drop in the average length of stay
• 50% reduction in 30-day readmissions
• $30-35M medical loss ratio savings

ONEcare is an Integrated System of Care (ISOC) deployed by a network of primary care, hospital, and behavioral health providers. It coordinates early disease identification, communication, priority access to care, and trust between patients and their care teams. This approach minimizes confusion, opens lines of communication, and empowers patients to seek and continue their behavioral health and substance use treatment. ONEcare networks, powered by ALERA Health, are self-governed and partner with payers and managed care organizations in pay-for-performance programs which incentivize improved patient health outcomes. Delivering the right care in the right place at the right time means hospital partners see significant decreases in charity care and increases in performance through reduced avoidable bed days and readmissions. More importantly, it helps patients get well faster and stay well longer.

To learn more about how Integrated Systems of Care like ONEcare can benefit your organization and those who rely on you for their health, start a conversation with the uncommonly good collaborators at ALERA Health. Together, we can save lives, one patient at a time. info@alerahealth.com  or call (833) 265-7549.

Citations:

• https://www.cms.gov/newsroom/press-releases/medicare-shared-savings-program-continues-grow-and-deliver-high-quality-person-centered-care-through

• https://www.ingentaconnect.com/content/wk/mcar/2018/00000056/00000007/art00002

• https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/

• https://www.cnn.com/2022/11/14/health/suicide-er-visits-kids

• https://pubmed.ncbi.nlm.nih.gov/31834399/