How ACOs Can Improve Health of Medicare Shared Savings Program Members

According to a 2019 report from the Department of Health and Human Services, strengthening patient engagement topped the list of care delivery strategies reported by the highest-performing Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). Managing complex care needs and reducing avoidable hospitalizations also were top strategies. And both were found to be dependent in large part on patient engagement.

This isn’t surprising. The CDC has also found links between active member engagement with better care outcomes and reduced costs.

But improving engagement among MSSP members can be challenging as MSSP members tend to be older, with a high prevalence of multiple chronic conditions (66% of all Medicare recipients have two or more chronic conditions). Additionally, many face challenges related to social determinants of health (SDOH) that can negatively impact engagement levels.

ACOs can overcome MSSP member health challenges and drive stronger engagement. And it honestly begins with the technology they are leveraging for care management. The right solutions can enable ACO care teams to execute strategies that help lift member engagement and improve members’ health.

Strategies and Medical Management Platform Essentials for Medicare Shared Savings Programs Members

Strategy 1: Spend More Time Establishing Personal Connections with Members

When repetitive tasks drain hours of the week, care managers lose time they could otherwise spend building connections, trust, and rapport with their MSSP members. Spending an extra 10 minutes getting to know members on a personal level (e.g., discussing health goals and concerns, inviting members to confide in social factors affecting their health) or utilizing motivational interviewing is critical to delivering value-based care and encouraging more active participation.

A care management platform with intelligent automations (task assignment or risk notifications.) and configurable workflows, templates, rule engines, and triggers that reduce care teams’ administrative burden. This allows for more time for member communication and care.

Medical management platforms that act as a centralized source of truth for member information across the care continuum, like VirtualHealth’s HELIOS. With HELIOS, member profiles are comprehensive and accessible to authorized care professionals across an ACO, saving time both on documentation and accessing the health information needed for accurate and efficient care planning.

See how HELIOS reduces complexity for ACO care managers >


Strategy 2: Support MSSP Members’ Tech Literacy Levels

A majority of MSSP members are Seniors or Boomers. While tech adoption is growing, these are still the least confident generations when it comes to technology.

For ACOs, this means two things. One, leveraging a care management platform with simple telehealth and communication tools. And two, care managers may need to act as “digital health coaches” for MSSP members. This second one might mean:

  • Making a preliminary call to go over how to connect via telehealth
  • Providing step-by-step instructions on accessing member portals
  • Offering supplemental hands-on demonstration and coaching with the use of RPM devices

For MSSP members, having integrated telehealth tools that don’t require extra software, logins, or technologies can go a long way to improving member health and activation levels.

Strategy 3:  Use Data from Members’ Digital Technologies

Mobile apps and wearable remote patient monitoring (RPM) devices are easy ways to get members to actively prioritize their health. Mobile health technologies remove barriers such as mobility challenges, lack of transportation, and geographic distance and provide the opportunity for more frequent data about a member’s health status.

RPM devices that give patients real-time data on key biometrics that help them gain a better understanding of their health (e.g., heart rate, blood pressure, glucose levels, oxygen levels), have been shown to build more active engagement and compliance with treatment protocols.

ACOs can leverage RPM data to implement a more proactive and preventive approach that may help to reduce hospital readmissions, better manage chronic complex conditions and diseases, and improve plan satisfaction rates. A care management system that captures and integrates this data into member views can be a time-and-money-saving solution for ACOs, especially those with a high percentage of complex care members.

HELIOS ADVANTAGE: HELIOS partners with organizations like Kangaroo Health to enable real-time data insights from various RPM sources that are integrated within the HELIOS platform patient views to provide care teams and providers with accurate real-time pictures of members’ health.

illustration of people donating food

Strategy 4: Identify and Address SDOH with MSSP Members

ACOs should collect data to identify MSSP members at risk of experiencing SDOH. They should also provide care managers with resources to connect members with community organizations such as food pantries, transportation services, housing assistance programs, and social/activity programs for seniors.

Social isolation, transportation, and housing are some common SDOH that may affect MSSP members.

To help, HELIOS can help ACOs proactively identify members with SDOH challenges and needs, as well as enable ACOs to connect with community organizations and resources designed to address SDOH. Partners like findhelp and UniteUs are just two examples. This integration with key SDOH partners alongside member views helps care managers to quickly identify health-related social barriers and connect members with needed resources in a few clicks.

Learn more about how HELIOS can help organizations address SDOH in this webinar with findhelp and NC INCK (NC Integrated Care for Kids) >

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