Palliative care providers engaging in Accountable Care Organization (ACO) relationships have the potential to make significant strides in bridging inequitable gaps of access.
Groups of physicians, hospitals and other health care providers voluntarily join forces in ACOs, which are designed to offer high-quality, coordinated care to Medicare patients. Collaborating or contracting with ACO networks can help palliative care providers better understand and address the leading barriers among underserved populations as they move across the continuum, said Empath Health CEO Jonathan Fleece.
The ACO reimbursement landscape includes incentives and quality measures designed to improve outcomes based on population needs. Providing palliative care through ACO relationships can result in greater potential to address patients’ full scope of medical, non-medical and psychosocial needs further upstream in their illness trajectories, Fleece stated, speaking at the recent Hospice News Palliative Care Virtual Summit.
“What is really important to understand around the model of ACOs and the economics behind it is these benchmarks, which are essentially assigned to the patient population that’s in the ACO,” Fleece told Palliative Care News during the summit. “These benchmarks are set regardless of skin color, sexual orientation or religion. It’s based on the health condition of a patient. Right there is a lot of equity.”
Hierarchical Condition Category (HCC) scores within Medicare payment assign numeric values to each beneficiary and are designed to help predict future health care costs based on a patient’s diagnostic information. These HCC scores set important benchmarks for palliative care providers to predict the greatest areas of need for their services and collaborate with other providers to improve reach among patients, a window that widens in ACO partnerships, Fleece indicated.
HCC scores provide insightful information around the social determinants of health driving decisions among specific patient populations. Palliative care providers collaborating with ACOs have the ability to demonstrate the value proposition of their services when it comes to supporting the most vulnerable and underserved seriously ill patients, he stated.
“These HCC scores are going to drive the better outcomes to then drive down costs,” Fleece said. “That is a great equalizer, because ultimately the way the system is set up is that the higher acuity patients are going to have the higher benchmark scores, regardless of these other factors. The more that participants and ACOs can figure out these social determinants of care and outcome models, then it’s really going to be able to drive the ultimate goal of what ACOs are designed to do: Improve health care outcomes for reduced costs.”
Health equity has become a top priority in emerging payment models, including the U.S. Centers for Medicare & Medicaid Services’ (CMS) payment model ACO Realizing Equity, Access and Community Health (ACO REACH). Launched last January, the model includes a high-needs component for serving the most complex and sickest patients.
The ACO REACH model is among those holding the most promise for palliative care providers to demonstrate the impact of their services when it comes to reducing disparities, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips LLP.
The payment model is designed to ensure that traditionally underserved communities receive care in a more proactive way, Banach said at the virtual summit. Palliative care providers can leverage their unique skill sets to drive more equitable care and improve patients’ quality of life, he added.
“Spiritual care, social work and a lot of the disciplines that really don’t exist within a lot of traditional primary care providers are disciplines that hospice and palliative care providers can bring to the table,” Banach told Palliative Care News. “That is going to be important if you’re looking at providing care in a more equitable way. If certain diseases are highly prevalent within certain populations, those are going to be important to focus on in terms of making a meaningful difference for that population. If the ACO is a traditional sort of primary care provider, that is also not necessarily doing great when it comes to this.”
