Going ‘Social’ – The Next Iteration Of ACOs

Executive Briefing | by | February 8, 2017

Monica E. Oss
Monica E. Oss

When it comes to accountable care organizations (ACO), we’ve seen a lot of new developments in recent months. The Centers for Medicare & Medicaid Services (CMS) have developed new models (see New ACO Developments, Same Challenges); many Medicare ACOs have reported that they are losing money (see Not All Medicare ACOs Are Winners); and some ACOs have been able to earn bonus payments by investing heavily in infrastructure (see Who Are The ‘Big Winners’ Of Medicare ACO Bonus Payments?).

If you’re keeping track of these developments, here’s another one for you — the emergence of “social ACOs,” which was the focus of the recent Health Affairs blog, Weaving Whole-Person Health Throughout An Accountable Care Framework: The Social ACO. This concept, pioneered at the Commonwealth Care Alliance (CCA), is built “on the idea that improving health and cost outcomes of vulnerable populations will necessitate incorporating health, behavioral health, and social services into the ACO model” (see The First Social ACO: Lessons from Commonwealth Care Alliance).

Sounds familiar? I thought so. Expanding ACO financing structures to target social determinants of health such as social, environmental, and community factors was something we covered a couple years ago with “Totally Accountable Care Organizations,” or TACOS (see TACOs, Anyone?).

What makes the CCA model, which serves 19,000 consumer who are dually eligible for Medicare and Medicaid, particularly “social”? First, it relies on increased investments in social supports and the stakeholder communication needed for financially integrated delivery systems. And financially, CCA receives global capitation payments for its members (for flexibility on how funds are spent) and serves as a provider/insurer that can “align its own payments with that of contracted providers.”

What does the CCA recommend for success in this care coordination environment?

Trusting, Longitudinal Relationships: Consumer engagement is important to health care success, no matter what “era” of strategic thought a provider organization operates under. But it’s critical for superior care coordination as well as identifying and meeting the “comprehensive human needs” of each consumer (see Social Media Listening As Consumer Engagement Strategy and Consumers Don’t Know What They Don’t Know).

Fully Integrated Financing Of Medical, Behavioral Health, And Social Supports Through Global Capitation: None of this is sustainable without financial integration, and global payment allows for a health care system-wide focus. These are fixed reimbursements for a specified population over a designated time period (see Population Health Management Strategies – The Hospital Perspective & Beyond and Are Health Plans The Future Of Social Service Funding?).

A Longer Time Horizon For Measuring Impact: Social services are not as immediately measurable as acute services, and judging effectiveness of these services takes longer. Accountable care needs “alternative retention incentives that enable them to increase their likelihood of realizing returns on non-medical investments” (see The ‘New’ Safety Net and Social Risk & The ‘Value’ Of Health Care).

Fierce Commitment To Community-Based Delivery Of Social Services With Bi-Directional Integration: Community-based specialty provider organizations are already on the market but need the financial incentives and appropriate levels of risk to add value to care coordination models (see The Local Approach To Medicaid ACOs and Strategy In The Era Of Medicaid ACOs).

Is this “the” model that can align the old, traditional view of health care with the new, accountable vision that takes into account all of a population’s health concerns? Time will tell, but watching the development is important either way. For many provider organizations and care coordination organizations, the ability to manage the behavioral health and social support needs is far from mandatory. But I think those days are limited. Integrated care coordination models are in wide use and even wider development as the search continues for the “complete” accountable care approach and health and human service provider organizations that can add to the value chain.

For more on the opportunities for community-based organizations seeking to work with ACOs, join me on Tuesday, March 28, at 1 p.m. Eastern for Rethinking Community-Based Services: Emerging Opportunities With Health Plans & ACOs — a webinar offered exclusively for OPEN MINDS Circle Elite members. Not an Elite member? Upgrade your account now to access OPEN MINDS Market Intelligence Reports, the Government RFP & Contract Database, special registrations to all OPEN MINDS institutes, and exclusive online executive education events.



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