The shift to value-based care is happening fast – the global value-based care payment market is anticipated to grow from $2.2 billion in 2022 to $2.47 billion in 2023 (about $8 per person in the United States). In addition, the Centers for Medicare & Medicaid Services (CMS) continues to implement redesigned policies reflecting health disparities, and many private payers choose to shift to value-based arrangements and Accountable Care Organization (ACO) models. With traditional fee-for-service healthcare models fading into the rearview, ACOs are a stepping stone for practices and physicians looking to jump into value-based care.
Although new care delivery models might seem intimidating, practices waiting to make the transition to value-based care miss several significant benefits that have major long-term major impact – for them, their practice, and their patients. Here are a few key benefits of participating in an ACO:
- Maximize financial rewards
The goal of an ACO is to ensure patients, especially those with chronic conditions, receive the right care, at the right time, at the right place – and ACOs financially reward and incentivize providers to reduce hospitalizations, medical errors, and the duplication of tests and services. When patient populations stay healthier, the ACO and providers generate shared savings, contributing to additional income. ACOs can also financially incentivize physicians who improve their practice workflows or participate in engagement activities like meetings or events. In the Vytalize Health ACO, the financial benefits are significant: engaged primary care physicians earned more than $50,000 for their work in 2021 and more than $150,000 for their work in 2022.
- Reduce healthcare costs
ACOs aim to reduce healthcare costs by eliminating unnecessary tests and procedures and promoting preventive care. By working together, providers in an ACO can reduce duplication of services and other inefficiencies, which can help to lower costs for patients and payers. ACOs can also reduce costs by leveraging their bargaining power to negotiate better prices for medical services, drugs, and medical equipment with healthcare providers and suppliers. Additionally, ACOs can encourage the use of cost-effective treatment options and promote patient engagement and education to help patients make informed decisions regarding their health.
- Improve patient experience and outcomes
CMS outlines several quality care measures focused on prevention (like cancer screenings and wellness visits) and managing chronic conditions (like diabetes, cardiovascular diseases, and hypertension). These measures often result in better patient care because conditions are caught, treated early, and consistently monitored, resulting in reduced wasteful spending. Physicians in ACOs are motivated to prevent developing diseases and conditions, as well as whole-person health, in addition to attending to immediate needs. In the Vytalize Health ACO, patients see their primary care physicians 78% more frequently than average, allowing for conditions to be caught and treated early, and then monitored consistently.
- Access to resources and services
ACOs take advantage of technology and implement solutions at no cost to providers and practices. These resources include actionable data in a single platform that helps providers identify the services each patient needs. Many ACOs also offer programs and services tailored to supporting the highest-risk and sickest patients that would be difficult for smaller practices or solo practitioners to operationalize on their own. Examples include the Vytalize Health Priority Care and Connected Care programs, which offer in-home health services, dedicated health professionals like pharmacists, and dietitians who meet one-on-one with patients to create customized plans together with the patient’s physician, as well as virtual vital monitoring, alerts, and access to 24/7 nurse phone lines.
- Coordinate care
In ACO models, physicians, hospitals, and other healthcare providers work together to provide coordinated care for their patients and are financially rewarded for this process. The ACO model also encourages families and caretakers to be active partners in patient care. Patients can better avoid costly hospital stays and procedures when all parties involved stay informed. Coordinated care within the Vytalize ACO has led to a 28% reduction in emergency department visits. Several ACOs are physician-led, ensuring doctors feel empowered to advocate on their patient’s behalf instead of according to insurance plans, and that those doctors are heard when it comes to implementing change and incorporating feedback within the ACO model overall. Many ACOs, like Vytalize Health’s, also ensure physicians remain independent and in charge of their own offices.
Although these models might seem daunting, the benefits of participating in an ACO outweigh delaying the inevitable shift all healthcare providers will be required to make. Vytalize Health is here to help every step of the way. In fact, 80% of participating providers were not involved in value-based care until they joined the Vytalize Health ACO, and 95% of practices choose to remain with Vytalize year after year.
Ready to join? Schedule a 15-minute call with Vytalize Health today to discuss details.