New to ACOs? Choosing the right partner can mean high quality care and generated savings

By: Sandeep Yadavalli, MD| Associate CMO | Sound Long–Term Care Management 

As collaborative groups of physicians, hospitals, and other healthcare providers voluntarily work together, accountable care organizations (ACOs) deliver well-coordinated, high-quality care to patients and represent a shift toward a more integrated and efficient healthcare system. ACOs have become important allies for many clinicians looking to improve care quality and finances. 

Eager to support an often-underserved patient population, we at Sound established Sound Long-Term Care Management (SLTCM) a little over a year ago. By ensuring timely and appropriate care, especially for those with chronic conditions, SLTCM’s goals are those of most ACOs: help our partners improve patient experience, enhance care delivery, prevent unnecessary service duplication, and minimize medical errors. 

When an ACO successfully achieves improvements in both quality care and cost savings, it often shares in the resulting program savings. The Centers for Medicare and Medicaid Services (CMS) has committed that by 2030, all Medicare beneficiaries will be in a care relationship. This mandate is to create accountability for quality and total cost of care, meaning that ACOs are here to stay as a central pillar of CMS’s strategic vision. And that begs the question – with so many options out there, how can you know if you’re choosing the right accountable care organization for you and your patients? 

Not all ACOs are made the same 

There are many kinds of ACOs, and they’re often grouped by the subpopulations being served, such as Medicare, Commercial, or Medicaid patients. Medicare has offered many different options and innovative models of ACOs for participants. Of these, one of the most prevalent is the Medicare Shared Savings Program (MSSP). 

MSSP, which began in 2012, has been the longest-running model with the greatest participation (as many as 480 ACOs,). While all these ACOs are required to report on quality, the financial risk they bear is spread across varying levels called tracks. This allows those new to the model to start with lower risk while more experienced organizations can take on more accountability for the cost of care and, therefore, the savings or losses that are generated.  

Basic tracks see ACOs assuming little risk in exchange for smaller reward in the form of shared savings for their partners. An enhanced MSSP track offers much higher shared savings for partners as ACOs take on higher risk. Click here for a full breakdown of the various characteristics under each track level. 

What to look for in an ACO 

Accountable care organizations are among the fastest-growing segments of value-based care in the U.S. Given the successful record since their inception, there has been an explosion of new ACOs that are joining the fray with many experienced organizations. As a practice leader, choosing the right ACO to partner with can have many significant ramifications. Consider whether the ACO meets these criteria: 

• Patient-centered: The most important piece of the ACO puzzle is improving patient care. Evidence of thoughtful design in care delivery, elements of patient equity, and a track record of improved clinical outcomes will help validate whether an organization’s work aligns with the kind of care your practice wishes to provide.  

• Clinician-focused: With the proliferation of ACOs, it can feel more like business than healthcare. Clinicians are the backbone of delivering care and integral to the heightened patient engagement that can result in success. Asking about an ACO’s clinician leadership and clinician-centered workflows will give quick clues as to whether an organization is seeking to solve clinical conundrums on the way to shared savings. 

• Technology-forward: Healthcare in the 21st century is data-driven and evidence-based. Looking for partners who leverage point-of-care tools, real-time analytics, and seamless data-sharing can make the process of change management a breeze. ACOs that can work with your current electronic health record (EHR) and billing vendors can often make many processes operate smoothly.  

• Process-driven and transparent: Successful ACOs have strong internal processes to share performance data regularly with transparency. Furthermore, look for evidence of thought partnership in translating the data into meaningful next steps that will help your practice succeed — these can be in the form of regular meetings, practice improvement tools, coding, and documentation education. 

• Financially sound: Shared savings are the central tenet of partnerships within ACOs. Look at the fine print for any reporting commitments, performance thresholds, and clawbacks. As they say, there are no free lunches, and if it looks too good to be true, it probably is. 

• Relationship-builders: ACOs are about partnership. Long-term and mutually beneficial relationships can be built over an ACO’s agreement period. Selecting the right partner is often about the right fit — ask for references to hear firsthand experience.  

The Sound difference: SLTCM, a leader among high-needs ACOs 

Sound Long-Term Care Management is an enhanced-track MSSP accountable care organization with a national footprint that started in 2023 to serve those individuals with the highest unmet needs. We focus on high-needs individuals in institutional settings like long-term care and assisted living facilities.  

What sets us apart is what we bring to our partners. See the Sound difference in our: 

Enhanced track 

Leveraging the deep expertise of the ACO leadership team in value-based care, we’re confidently enrolled in the highest-risk track on offer — the enhanced track — where we’re eligible for 75 percent of first-dollar savings.  

Physician leadership 

SLTCM is unique in that it’s led by tenured clinicians with deep experience in value-based care and innovation. This allows us to think from our partners’ shoes as we define goals, design workflows, and identify challenges. Furthermore, with full-time dedicated clinical leadership, we’re committed to being thought partners to our participating provider groups through a regular cadence of performance meetings and data sharing.

Innovative care model 

SLTCM’s care model includes the below four pillars: 

1. Proactive care  
   • By leveraging annual wellness visits, best practices on chronic conditions, and creating unique specialty partnerships, we focus on elevating what is commonly known as usual care in these facilities. 
2. Telemedicine 
   • Bringing virtual care to the bedside in long-term facilities means real-time access to a clinician who can potentially treat a patient in place and reduce avoidable transfers to the emergency department. The impact on patient and clinician satisfaction is immense. 
3. Point-of-care tools 
   • We employ tools that overlay usual clinician workflow in major EHRs to bring real-time visibility to risk adjustment, quality gaps, and patient risk scores without the need to leave their usual electronic workspace. 
4. Chronic care management (CCM) 
   • Paired with proactive clinical care from primary teams, CCM can reduce decompensations of chronic illnesses, which accounts for most avoidable health care costs. 

Quality-focus 

Sound Long-Term Care Management has the distinction of achieving an exceptional reporting rate in our first performance year. We’ve built a strong team with intimate knowledge of EHRs, coding systems, and reporting registries to demystify quality reporting for our partner providers. 

Interested in learning more about SLTCM?  

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