Diabetes And Accountable Care Organizations: A Value-Based Care Strategy
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Diabetes is a major contributor to rising healthcare costs in the US, affecting over 30 million Americans. As the healthcare system shifts from fee-for-service to value-based care, Accountable Care Organizations (ACOs) are well-positioned to address the complexities of diabetes prevention, treatment, and management. ACOs focus on wellness, population health management, and value across the continuum of care. They are evaluated on quality measures related to diabetes that cover prevention, treatment, and management. Their coordinated care model and focus on quality make them suited to improving diabetes outcomes while reducing unnecessary costs.
Diabetes And Accountable Care Organizations: A Value-Based Care Strategy
- 1. DIABETES & ACOS BY TXCIN A VALUE-BASED CARE STRATEGY
- 2. In today’s healthcare system, diabetes, and treatment associated with the disease, continues to be a major contributor to rising healthcare costs. Diabetes remains the 7th leading cause of death in the United States, affecting 30.3 million Americans in 2015, or 9.4% of the U.S. population.
- 3. As the healthcare environment shifts from traditional fee-for- service (FFS) to value-based care, Accountable Care Organizations (ACOs) are positioned to play an influential role in successfully addressing the complexities of diabetes prevention, treatment, and management.
- 4. The traditional healthcare system is built upon the fee-for- service, or quantity-over-quality, reimbursement framework, where physicians are paid solely on services provided, and where limited coordination exists between specialties. Often patients are left to navigate through the healthcare system alone, which can be confusing, frustrating, and overwhelming, especially for patients who are dealing with the physical and emotional challenges of a chronic disease. TRADITIONAL HEALTHCARE APPROACH
- 5. In the value-based care environment, clinicians intentionally consider the quality of care provided, and the overall outcomes of that care, in relation to cost-efficiency. Physicians and specialists consider “best practices” when treating patients, since they are reimbursed for the quality and efficiency of care they provide. In other words, value-based care emphasizes more proactive, patient-centered, coordinated, and efficient care, predicated on quality performance. VALUE- BASED CARE APPROACH
- 6. ACO STRATEGY FOR DIABETES CARE Accountable Care Organizations are at the forefront of the value-based care movement. ACOs are voluntary networks of physicians, specialists, surgeons, clinics, care coordinators and educators, dieticians, nursing homes, pharmacies, and hospitals who agree to coordinate care for a patient population, with the goal of improving quality care, while eliminating unnecessary spending. In short, ACOs focus on wellness and prevention, population health management, and value across the continuum of care.
- 7. ACO STRATEGY FOR DIABETES CARE Studies project that 1 in 3 people will develop type 2 diabetes by 2050, placing them at high risk for developing serious health complications, including cardiovascular disease, stroke, blindness, kidney disease and kidney failure, heart disease, and non- traumatic lower-limb amputations. Diabetes patients can require an enormous amount of care, leading to expensive healthcare costs, 2.3x greater than patients without diabetes; however, with their strategic, coordinated-care emphasis and reach, and their focus on quality performance, ACOs are distinctively suited to address the complexities of diabetes care.
- 8. For example, under the Quality Payment Program (QPP), ACOs are graded on 31 quality measures (29 individual measures and one composite that includes two individual component measures) spanning four quality domains:
- 9. C A O Patient / Caregiver Experience Care Coordination / Patient Safety Preventive Health Clinical Care for At- Risk PopulationsS
- 10. Diabetes related performance measures exist in all four quality domains, collectively covering approximately 75% of the required quality performance measures. This focus underscores how diabetes and its related complications are a significant concentration of healthcare resources in the U.S. and how there is an increased intentionality by CMS to focus on quality care and efficiency in diabetes prevention, treatment, and management. http://www.insight-txcin.org/post/diabetes-and- accountable-care-organizations-a-value-based-care-strategy
- 12. ABOUT TXCIN North Texas Clinically Integrated Network, Inc. (dba TXCIN) is a non-profit ACO that began in late 2014. A small group of independent physicians aligned to initiate clinical integration and value- based contracting. Partnering with RevelationMD and its state-of-the art information platform, TXCIN has become the largest independent network of physicians in North Texas.