.jpg "Daniel Godla")
Care management is a particularly good fit for Medicare Accountable Care Organizations (ACOs) because it aligns with the ACO model’s fundamental goals and incentives.
That said, Medicare ACOs often struggle with executing effective care management, despite being built to coordinate care for specific patient populations or chronic conditions.
ThoroughCare, a leader in care management best practices, has worked with ACOs to improve care efficiency, as highlighted in our case study with Bridges Health Partners. We support clinical workflow development with expert advice and a software platform that simplifies compliance.
Let’s examine the reasons why Medicare ACOs struggle to maximize care management performance. Following that, we’ll review a few strategies to optimize workflow, patient engagement, and performance.
Ways Medicare ACOs struggle with care management
ACOs can run into a host of issues when they:
- Create care coordination processes
- Develop internal record systems
- Utilize features inside their electronic health record (EHR
Providers that rely on their own internal system or an EHR may miss out on making the most impact with their care management programs. Paper- or spreadsheet-based organization and EHR-based tools can lack optimized structure, automation, or evidence-based standards. Care management services need these to achieve high-performance outcomes and efficiencies that scale.
The most often-cited challenges ACOs report to the ThoroughCare team include:
- Limited workforce makes it hard to scale care management
- Lack of interoperable systems and access to varied patient data
- Identifying and managing patient populations effectively
- Inconsistent and ineffectual patient engagement
- Gaps in preventive care
- Complicated compliance, regulatory, and documentation burdens
- Integrating and managing care coordination workflow
- Inadequate insight into care management performance
How ThoroughCare levels up high-performing care management in ACOs
Medicare ACOs possess invaluable experience and a unique team-based model, dedicated to delivering coordinated and efficient care to senior populations.
ACOs that work with ThoroughCare can create a more integrated, patient-centered, efficient, and scalable care management service because of our platform, advisory services, and training.
The combination of all three—technology, support, and education—optimizes each ACO’s unique strengths, creating a streamlined, standardized, successful, and scalable approach.
Together, our team, the ACO’s leadership, and care providers can address each care management challenge, realizing greater revenue, patient satisfaction, and lower care costs.
Challenge 1: Patient Engagement
Care coordination activities need to follow clinical and operational protocols and policies for how the ACO wants to work with and engage patients consistently.
ThoroughCare’s platform provides the rigor of evidence-based assessments, workflows, and guided tasking. This standardized structure aligns with care management best practices and proven methodologies, enabling care teams to manage complicated patients more easily with regular, consistent, and progressive action. Within a standardized framework, however, ThoroughCare enables personalized care planning and activities tailored to each individual patient.
Compliance concerns due to ad hoc data capture and billing are mitigated by automated time tracking and documentation.
Challenge 2: Documentation Compliance
Care management activities cannot be fully optimized for efficiency and outcomes unless they are integrated seamlessly with the care team’s workflow.
ThoroughCare’s Clinical Advisory Services team provides a comprehensive opportunity analysis to assess areas for further streamlining workflow efficiency, patient engagement, compliance, and billing.
Based on their findings, the team strives to ensure that data sources, such as EHRs, are integrated and accessible, utilizing that data effectively to take meaningful action throughout the patient’s journey.
Additionally, our expert trainers help care managers and the entire care team use the software optimally and learn best practices, evidence-based care, and AI-generated features embedded in the platform. Training is tailored to the ACO’s unique needs and performance objectives.
Challenge 3: Having the Right Tools to Scale
ACOs can engage the most patients and grow their care programs when they use reliable systems and technology. These tools can make their operations easier and frees up physician focus for direct patient support.
The ThoroughCare software enables care managers and leaders to enroll new patients into a new program and start implementing new care models instantly. Using artificial intelligence tools alongside guided assessments, care plans, and workflow automation reduces time-consuming administrative tasks, such as planning patient calls.
How AI Helps the Care Team Make the Most of Patient Calls
Before the call
ThoroughCare's AI automates the initiation, receipt, recording, and transcription of every patient call. The platform analyzes the call data and transcripts to create conversation guides.
The conversation guide lists each prioritized topic from the last call, along with links to relevant citations from previous transcripts.
During the call
Because AI does most of the prep, the care manager can be more present with the patient. This allows the care manager to address not only their priorities but also focus on what's top of mind for the patient.
Through the conversation guide, AI capabilities index a topic checklist that care managers can use in real-time to guide the conversation and engage the patient in an organic and personalized way.
After the call
Once the patient call is complete, our AI tool automatically takes the transcribed call data, analyzes it, and converts it into actionable care plan suggestions. The care manager can review the recommendations and instantly import the details into ThoroughCare.
Not only does the care manager have AI-generated call transcripts and care plans, but they have all the necessary documentation for this call and a prioritized list of topics for the next one.
Care managers no longer need to spend time recapping what was discussed with the patient and documenting key details. Now, AI does it automatically for them.
Successful
ACOs rely on risk stratification, data analysis, and population health management to track performance and patient outcomes. This is crucial for care management programs that are implemented to achieve specific clinical objectives and generate revenue through shared savings or contractual rewards.
ThoroughCare provides robust data integration, analysis, dashboards, and reports that allow the care team and administrative leaders to have a transparent view into engagement, enrollment, and outcomes, as well as see trends for making patient-, population-, or practice-level improvements.
ThoroughCare enables high-performance ACOs
By combining software, advisory services, and training, ThoroughCare is your partner to improve ACO care program ROI by 10-15x. We give providers the tools and insights to run successful care management services.
Our software offers functionality suited to the care management needs of ACOs, including:
- Performance metrics and cost reporting
- ACO oversight across members, including group functionality
- Medicare care management compliance and billing
- Timely interventions
- Personalized care plans
- Data integration and interoperability
ThoroughCare’s Clinical Advisory Team collaborates closely with healthcare organizations to enhance competency, ensure compliance, and optimize operations, enabling them to achieve their care coordination objectives. We combine this expertise with a comprehensive software platform to help providers and care management organizations follow best practices.
Key questions answered
Why do Medicare ACOs struggle with self-built or EHR-driven care management?
Paper- or spreadsheet-based organization and EHR-based tools don’t provide enough structure, automation, or evidence-based standards that ACOs need to implement an effective care management program and achieve high-performance outcomes or efficiencies that scale.
With the right technology, support, and education, each ACO can leverage its unique strengths and create a streamlined, standardized, successful, and scalable approach to care management.