The document discusses the transformation of the American healthcare system through accountable care organizations (ACOs) and collaborative care models, which aim to enhance patient outcomes while managing costs. It outlines the benefits of ACOs for both healthcare providers and patients, emphasizing improvements in care coordination and patient engagement. Moreover, it highlights the ongoing shift from volume-based to value-based payment systems as a crucial aspect of sustaining healthcare transformation.

1. How to think like an ACO
Why Healthcare is Changing1
So What Exactly is Collaborative Care?2
Cost Drivers: Value vs. Volume3
ACO/Collaborative Care Benefits4
Accountable care—
What’s in it for you
(and your patients)?

2. Why healthcare is
changing.
1
CHAPTER

3. Imagine this…
a healthcare system where people, though living longer,
are healthier than previous generations. The quality of care
is continually improving. And the cost of care delivered is
affordable for all Americans.
Now picture this…healthcare providers across the country,
ranging from primary care doctors to specialists, from
hospitals to large health systems, are all collaborating with
each other to improve health outcomes for their patient
populations—and getting paid well in return.
Now that’s Accountable Care!
The American healthcare system is changing rapidly, with no end in sight.
It’s fragmented and its costs have been unsustainable for decades. Our
population is aging while people are living longer. Today, the needs of
chronic care patients and the elderly drive approximately 75% of
our nation’s healthcare costs. Plus, chronic disease is the leading cause
of death and disability in the U.S.—and very costly to treat.

4. 2
CHAPTER
So what exactly is
collaborative care?

5. Accountable care organizations (ACOs) integrate local physicians with other members
of their healthcare community and reward them for controlling costs and improving quality
While ACOs are not radically different from other efforts to improve the cost-effectiveness of healthcare delivery—
such as health maintenance organizations (HMOs), physician-hospital organizations (PHOs), and independent practice
associations (IPAs)—their innovation lies in the flexibility intrinsic to their structure, payments, and risk assumption.
How does an ACO work?
Similar to physicians in integrated healthcare delivery systems—such as the Mayo Clinic, Geisinger, and Intermountain
Healthcare—ACO physicians are accountable for the outcomes and expenditures of their patient population. They are
tasked with collaboratively improving care to achieve cost and quality goals set by payers. ACOs can be voluntary or
involuntary, distribute bonuses when targets are met, and levy penalties when targets are missed.
What are an ACO’s pieces and parts?
“Its components include patient-centered
care with an orientation toward the
whole person, comprehensive care,
care coordinated across all the elements
of the health system, superb access to
care, and a systems-based approach to
quality and safety.”i
“Ultimately, these components
are intended to improve patient
outcomes—including better patient
experience with care, improved
quality of care (leading to better
health), and reduced costs.”ii

6. 3
CHAPTER
Cost drivers:
value vs. volume.

7. Adopt collaborative care now
The sooner providers adopt collaborative care models, like ACO and PCMH,
the more likely they are to increase value—and not only share in savings, but
also share in a greater portion of the system savings. Achieving results, however,
is a multi-year process that requires a significant investment in time and resources.
Engaged healthcare consumers and providers
Value breeds a new type of healthcare consumer. One that is more engaged,
satisfied, and healthy. Patients and providers with these characteristics are
fundamental to improved outcomes. Better adherence to treatment
recommendations, follow-up, and prevention are all activities that affect
outcomes, but are required of patients and made easier with engaged providers.
Value doesn’t = volume
Healthcare value doesn’t come from volume but rather from results for lower
cost, achieved by providers who develop expertise, reduce errors, increase
efficiency, and improve outcomes. Value is, therefore, an indicator patients
can use when choosing where to get care.
Value-based payment models:
Public and commercial markets are
deploying new payment models with
value as the target. Commercial
efforts have already saved millions
annually. CMS actuaries project that
the Medicare Shared Savings Program
could save as much as $1 billion over
three years. That number is under 0.10
percent of total Medicare spending.
Medicaid is also launching models in
more than five states across the country.V
Today, it’s common knowledge that the cost of healthcare will continue to rise.
As healthcare becomes a greater portion of expenses for employers, public and
private insurers, and even patients, there is an increasing focus on efficiency
and value. Given this pressure to achieve better value for healthcare, it is safe to
assume that investment will level off and likely decrease over time.

8. 4
CHAPTER
ACO, collaborative
care benefits.

9. NextGen Healthcare ACO/
Collaborative Care Solutions
Collaborative care is not any one
product or service. It is a concept
that is framed and supported
first by proper business planning
and then by the optimal use of
organizational, clinical, financial,
and technical resources. It does
not come from “out-of-the-box”
solutions and is not “plug-and-
play.”Rather, it is a very business
- and staff-intensive concept that
requires expertise.
Benefits for PROVIDERS:
• Gain immediate access to clinical information
• Improve workflow and care coordination
• Enhance communication with all members of
the patient’s care team
• Prevent, diagnose, and treat certain diseases or
combinations of conditions, in particular
complex cases
• Improve the application of evidence-based medicine
through disease management protocols and clinical
decision support
• Increase physician and staff job satisfaction by
creating a “hassle-free” clinical practice
Benefits for PATIENTS:
• Deliver coordinated care across physician offices
and hospitals
• Achieve better health outcomes
• Enable all care team members to access full
medical history
• Stop repeatedly filling out forms on medical history
and repeating unnecessary tests
• Increase patient engagement and satisfaction

10. NextGen Healthcare collaborative care experts help providers reach
collaborative and ACO goals, with services that include:
Education and Strategic Planning
• Health reform megatrends: The impact they will
have on an organization
• Organizational preparedness and transformation
• New delivery models
• Healthcare policy and regulatory analysis
• Healthcare community partnerships
Organizational Transformation
• Cultural planning: staffing models, change
management, new models
• Clinical and business transformation
• Application of technology
Program Assistance
• Funding discovery: matching funding
opportunities to client needs
• Funding-related advice, consulting, and
relationship management
• Funding response writing and planning
• Program execution assistance based on
specific programs
Learn more about
NextGen Healthcare.
Watch an online demo at
nextgen.com/ACO

11. EDU30 - 4/14
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Systems, Inc., provides integrated clinical, financial and connectivity solutions for
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respective owners.
i
See http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__
home/1483/what_is_pcmh_ for AHRQ’s definition of the PCMH.
ii
See Berwick et al. (2008) for a discussion of this “triple aim” of better patient
experience, improved population health, and reduced per capita costs.
iii
“Health Policy Brief: Next Steps for ACOs,” Health Affairs, January 31, 2012.
iv
Meyer, H. Many Accountable Care Organizations Are Now Up and Running,
If Not Off To The Races. Health Aff (Millwood). 2012; 31(11):2363-2367.
v
Burns LR, Pauly MV. Accountable care organizations may have difficulty
avoiding the failures of integrated delivery networks of the 1990s. Health
Aff (Millwood). 2012;31(11):2407–16.
Take the next step.
Get better results with collaborative care.
For additional ACO information and client
stories, contact us at (855) 510-6398 or
EHResults@NextGen.com.