A big surprise for many new accountable care organizations (ACOs) is that the majority of their patients receive a large percentage of their health care from providers outside their network. This out-of-network utilization (sometimes called “leakage”) creates challenges for ACOs because it impacts their ability to manage care and costs effectively, and limits their ability to achieve the “triple aim” for enhancing the health system: improved population health, improved patient care experience and lower costs.
What drives an individual to choose out-of-network care? The catalyst may be an individual’s desire for choice, or, more important, his or her ability to navigate and access care in the complex health system. Many individuals must navigate the system by conducting their own research to find a physician or make an appointment.
The key to an ACO’s success is to make it easy for individuals to access care from its network of providers.
24/7 Consumer Navigation
ACOs that offer a 24/7, one-stop service to help patients find and receive care from its network of quality providers will be positioned for success in the new health care landscape.
The ACO can help individuals navigate the system and access care to find the right provider based on his or her specific requirements. The service should provide the individual with appointment preparation instructions (approved by the physicians), a map to the office, appointment reminders and follow-up steps using the individual’s desired communication method.
Making it Easy to Find a Podiatrist – Best Practices
Here is an example that illustrates how ACOs can make it easy for patients to access care from a network provider. An avid runner with foot pain contacts her ACO’s consumer navigation service to find a podiatrist. Here is what the ACO offers:
- Finds a podiatrist in the ACO network who is close to the individual’s home, offers after-hours appointments and specializes in long-distance runners.
- Makes an appointment and sends the individual instructions to drive to the physician’s office, reducing the time the individual spends trying to get care.
- Calls the individual with an appointment reminder, reducing no-show rates.
- Prepares the individual for the appointment by communicating specific instructions (e.g., bring his or her work shoes and sneakers) to improve the diagnosis.
- Follows up with the individual based on the provider’s feedback.
- Surveys the individual regarding the provider’s performance to measure patient satisfaction.
Because the podiatrist is in the ACO network, the visit will be charted in the electronic medical record, making other ACO physicians aware of the visit and outcome – which ultimately supports continuity of care and patient satisfaction goals.
Making it easy for people to access care is a vital step to help ACOs achieve their “triple aim.”