Care Management Support for Accountable Care Organizations

ACOs often consist of multiple independent practices or clinics. It can be hard to implement care management uniformly. We serve as a centralized resource that all participants in the ACO can leverage. This ensures a consistent, best-in-class approach to care coordination and chronic disease management across the network. It also eases the burden on smaller practices in the ACO that may not have resources to do it themselves. We basically bring everyone up to a high standard together. Learn more about chronic care management.

We work with ACO data (claims, risk stratification) to target who needs care. We might get lists of high ED utilizer patients, rising risk patients (using ACO predictive models), etc., and then design interventions for them. Our nimble team can implement targeted programs (e.g., a diabetes outreach campaign across the ACO population, or focus on patients with multiple admissions in past year). We then feed results back into the ACO’s analytics – showing improvements in those patients’ utilization or health metrics. We essentially help the ACO make data-driven quality improvements, acting on the insights to produce outcomes. Learn more about panel management.

For ACO success, physician engagement is key. Because we impose no additional administrative burden on physicians and staff, ACO providers are more receptive to our involvement. We aren’t asking them to do more documentation or make more calls – we do it and make their lives easier, as described for provider groups. This enhances provider satisfaction within the ACO, which is crucial for ACO’s long-term stability. Doctors see that the ACO is providing resources (like us) that actually help them and their patients, rather than just telling them to do more work for value-based care.

Our programs reduce avoidable expenditures by preventing hospital admissions and ER visits through better chronic care and post-discharge support. ACOs typically share in savings when cost of care is reduced. By identifying at-risk hypertensive and diabetic patients and providing continuous high-touch care coordination and remote monitoring, Brilliant Care improves outcomes with zero distractions for physicians and staff – only enhanced patient care. This proactive approach yields fewer complications and crisis events, which translates to real savings. For example, fewer CHF exacerbations needing admission, fewer patients with diabetes showing up in the ER with DKA, etc. See our clinical and operational impact.

ACOs are measured on quality metrics (many of which overlap with CMS Star and HEDIS measures). We bolster performance on these metrics by closing care gaps and managing chronic conditions effectively. For instance, we improve medication adherence and monitoring (helping med reconciliation post-discharge, ensuring patients fill meds – impacting adherence measures). Patients in our care are more likely to receive guideline-recommended preventive care, which is crucial for ACO quality scoring. Also, our high patient engagement can reflect in higher patient experience scores (CAHPS, etc.). One ACO leader might say: “When a value-based care initiative can positively impact outcomes and costs, it’s worth exploring. The problem isn’t in the providers’ exam rooms; it’s outside them, at home, where costs rise. That’s where we move the needle.” We provide that home engagement that moves the needle on all those metrics.

We often structure contracts as a pay-for-performance model where the ACO pays only if we achieve certain agreed upon objectives. This makes it financially attractive for ACOs to implement us – essentially no financial risk, but a lot to gain. It’s a true partnership.