Accountable Care Organizations: Getting The Pros Without The Cons

While the definition continues to evolve, accountable care organizations (ACOs) are essentially groups of healthcare providers—sometimes even hospitals—that come together to provide coordinated care and population health management.

Imagine you're a provider, and you decide an ACO is right for you. That means you have a financial incentive to provide higher quality care at a lower cost for the patients who are part of this ACO.

See the dilemma? Even though you have a substantial number of ACO patients, you also have many who are not.

There's just no way it can work effectively. Here's why:

1. The broader care team is probably not going to know which patients are ACO patients.
2. And even if they did, they don't have the time or the resources to manage patient care any differently.

But what if you could deliver the same kind of quality care as an ACO, only with better control? At Vera, that's what we do.

Identifying The Narrow Network

Vera can accomplish all the good of an ACO, but within a specific, defined population.

After analyzing more than two years of historic claims data, we have a clear view of the risk of each population, the best opportunities to improve health, and how we can drive better outcomes, all the way down to the individual member.

One of the reasons we've been so successful at managing care for defined populations is our commitment to build care teams and even entire care centers that are dedicated to only one group of people. Population health management is simply contained within a narrow network.

In every other traditional primary care practice, that's just not possible. Especially when providers are expected to see 25 to 30 patients a day.

It's all the benefits of and ACO, but without the unknowns.

Leveraging High-Quality, Low-Cost Providers

Because we're in a controlled environment, it's easy to understanding how a patient's entire health plan operates.

But even more importantly, we're not controlled by any particular health system. So we can be completely system-agnostic to ensure that our patients receive high-quality, low-cost referrals that fit into their benefits plans.

It's not that patients suddenly lose their power to choose—far from it. The beauty of a controlled environment, unlike an ACO, is that patients can choose from a list of carefully vetted specialists to provide care when necessary. These specialists are all in network, so patients aren't risking higher out-of-pocket expenses by pursuing care they need. But the biggest benefit is that the referrals and all the care coordination is done for them.

Coordinating And Managing Care

At Vera, we do everything we can to ensure that there aren't any gaps in a patient's health journey. Each patient is assigned a dedicated care team made up of a provider, health coach, and medical staff members.

We use the term “dedicated care team” because each member of the team is working collaboratively on a personalized care plan for each patient. This creates a comprehensive approach to care that gives the patient a path to better health from the perspective of both providers and coaches.

When it comes to referrals and care coordination, our care teams are responsible for closing the loop—following up with the patient and the receiving provider after the referral to make sure that everything's working the way it should.

We have the time to do that. We have the financial incentive to do that. And because we're focused on a specific population, we can actually deliver. But most importantly, we just believe it's the right thing to do.

If you're interested in learning more, we've got a great resource for you. Download our white paper, Delivering Managed Care The Way It Was Intended, and start digging in.