Engaging Primary Care Clinicians Is Key to ACO Efforts to Provide Tailored Services for High-Need Patients
Seeking to provide the most appropriate, cost-effective care possible, accountable care organizations (ACOs) in the U.S. typically group patients by their level of health risk. But this level of risk stratification, many experts say, is not enough to identify the individuals most likely to benefit from specific interventions.
A few ACOs go further: they segment their highest-risk patients into smaller subgroups, allowing them to tailor care management and other services to each one’s needs. In a new Commonwealth Fund report, researchers led by Ann O’Malley of Mathematica Policy Research explore the segmentation strategies used by mature ACOs for their high-need, high-cost patient populations and discuss the challenges these organizations encounter.
The study’s findings suggest a hybrid approach that takes advantage of both quantitative and qualitative data is the most effective at identifying the patients most likely to benefit from intensive care management, including services that address behavioral health issues, social needs, and coping skills. Moreover, by engaging primary care clinicians in the process, ACOs can maximize the usefulness of segmentation results as well as the likelihood that clinicians will “accept the results…which in turn affects whether patients accept enhanced care management services.”
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