The Journey to Risk: 3 strategies to achieve success in an ACO model

Scan the MHN ACO website and a few themes quickly emerge. Phrases like “equal partners,” “shared decision-making,” and “true collaboration” leap off the page, along with the headline that this is a “different approach.” Launched in 2014, MHN ACO is one of the true success stories of the Medicaid ACO model. As it heads towards completion of its first full year taking on downside risk, Elizabeth Simpkin, SVP of ACO Operations for Medical Home Network, was kind enough to walk us through how MHN ACO’s success is derived directly from these themes, which serve as the foundation for the organization’s innovative approach.

For Simpkin, everything begins with MHN ACO’s commitment to equal partners. MHN was founded to improve the health and quality of care for Medicaid patients in Chicago’s south and southwest neighborhoods. This population presents unique challenges, as Medicaid patients do in other regions, related to eligibility and non-clinical barriers impacting health (or social determinants); such as, lack of transportation access. To successfully engage its members, MHN ACO relies on a decentralized model of care that brings care management to the practice level. MHN ACO member organizations deliver care management at the point of care, as opposed to as a centralized function delivered by a health plan. In this manner, ACO partners have been able to “use those touchpoints to perform a variety of critical tasks—like build personal relationships with members, keep on top of eligibility, and maintain the primary care physician relationship,” according to Simpkin.

Shared decision-making is enabled by a patient’s care team having access to the same information. Technology, in the form of a population health care management platform, knits the ACO together, enabling a patient-centered approach to care management that begins with the completion of a health risk assessment before building out a risk profile, shared care plans, workflows, and a longitudinal patient record inclusive of medical, behavioral and social information. Spearheaded by a care manager, care plan tasks are assigned, obstacles can be identified and mitigated, and whole patient care is delivered by a patient’s personalized care team.

As MHN ACO demonstrates, the right people, process and technology are integral to delivering on the promise of true collaboration. Understanding and analyzing past performance, and having the data and predictive capabilities to feel confident about future trends, allowed MHN ACO to focus their resources appropriately—and to feel confident in moving to downside risk.

By maintaining these key tenets, Simpkin believes MHN ACO will continue to see successes. Her parting advice for ACOs: “One thing you can count on, is that the healthcare ecosystem is only going to become more complex. If you focus on those people who are most able to be helped, trying to mitigate healthcare challenges through care management and patient engagement, you’ll be able to stay ahead of the more challenging external forces.”

To learn more about how Texture Health’s population health care management solution empowers ACO success, contact us to schedule a demo.

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