Early detection of acute illness is a critical ACO success factor. It is also critical for providers interested in risk sharing arrangements and value-based care. ACOs and other population health initiatives need systems which support earlier detection and earlier treatment for illness episodes which carry the risk of requiring ER and inpatient care.
For an ACO, the concept of “early detection” applies to any illness episode that has the potential of needing ER and/or inpatient care. The majority of such illness episodes occur in the population already identified as having one or more chronic disease.
What Needs to be Done?
Your ambulatory delivery system needs to be enhanced to provide earlier and better access to treatment for patients at the earliest possible stage of an acute illness episode. The goal is to prevent the illness from progressing to a stage requiring ER visits and hospital admission.
We find that providers and organizations in the early stages of their accountable care journey often miss the importance and complexity of the patient access and communication process. Regular communication
between the patient and their usual provider and appointment access to that provider are critical to preventing ER visits and hospital admissions.
COPD is one example. Essentially all patients with chronic illness are at risk for an episode of illness capable of generating ER and inpatient costs.
Enhanced early detection systems to prevent these ‘avoidable’ ER visits and admissions are absolutely essential for ACO success. For a 25,000 beneficiary ACO you’ll need to prevent about 20% of your patients’ emergency room visits and about 10-15% of their hospital admissions to achieve savings of 4 – 6% and trigger gain sharing.
Engaging Primary Care for Early Detection
Successful ACOs are organizations in which primary care plays a key role. Primary care’s engagement and understanding of how value is created is necessary for ACO success because primary care providers are the critical point of access and communications for most patients.
An ACO that fails to address early detection through enhanced primary care access and communications will fall short of its savings goals. Early and appropriate intervention in an illness episode requires changes in many basic primary care systems. To be effective, these changes require support by primary care, adequate resources and rapid effective implementation.