Medical management platforms can help accountable care organizations (ACOs) meet core goals related to providing highly coordinated, value-based care.
For example, software with automated workflows and data centralization capabilities helped ACOs increase primary care services and wellness rates among members while reducing emergency department visits, hospital readmissions, and overall costs, according to a 2017 report in Healthcare IT News.
But, with many medical management platforms in the market now, which is right for your organization?
Medical Management Software for ACOs: 6 Critical Considerations
An ACO should look for a medical management platform that provides the tools and resources to cost-effectively optimize care coordination, care team communication, and member engagement and health.
It also comes down to choosing one that meets basic criteria like security, scalability, and vendor reputation, while ensuring that the platform’s offerings align with organizational objectives.
While these objectives may vary, six key platform capabilities stand out as critical in helping ACOs improve the delivery of value-based care. Here’s what to look for.
1. Care coordination tools
Look for software that facilitates care coordination across diverse healthcare settings with tools to enable communication, collaboration, and secure sharing of member data.
The ability to centralize member data in real-time as well as ease of use (e.g., requiring minimal clicks to navigate to a member view) are critical. Features like appointment scheduling, referral management, and secure messaging are examples of tools ACOs can use to strengthen care coordination.
2. Member engagement and communication tools
Medical management software should also make it easier for care managers to actively involve members in their healthcare. This can include telehealth tools like email, SMS, and video conferencing options to boost participation, as well as member portals, and appointment reminders.
3. Management of chronic disease and complex conditions
Built-in automations, assessments, and intelligence features can help identify individuals with, or at risk for, complex conditions who could benefit from advanced disease management or intervention.
For example, HELIOS includes unique assessment, clinical decision-making pathways, and risk and task automation features based on evidence-based best practices to help care managers by identifying high-risk individuals, prioritizing care management tasks, and auto-populating individually tailored member care plans.
ACOs should also look for automations such as in-platform referrals, assessment generation, and task assignments and reminders. (Like you can find in HELIOS).
4. Population health management tools
A solution with strong population health management capabilities can help ACOs understand trends and predict future needs. This allows ACOs to identify gaps in care, intervene early, provide targeted care management, and prevent adverse health outcomes among target populations.
To support population health management, look for platforms that offer:
- Data collection and analysis capabilities of member data from sources such as EHRs, claims data, and social determinants of health (SDOH)
- Comprehensive reporting functionalities
- Ability to generate quality metrics and performance reports
5. Utilization management (UM) tools
Traditionally, UM has been siloed from care management technologies. But some medical management platforms offer UM and CM together. This can enable ACOs to better align UM and care management teams for a more holistic approach, which translates to proactive and personalized care planning for members, faster authorizations, reductions inaccuracies of care, and cost savings.
On the provider side, it also empowers higher-value treatment decisions and reduces delays in connecting members with necessary interventions.
And by monitoring utilization patterns and outcomes, ACOs can also identify areas for improvement, reduce variations in care, and promote the delivery of high-quality, evidence-based care.
Look for UM capabilities that enable you to:
- Automate the triage and approval process and the creation of member timelines
- Build intelligent workflows that reduce duplication of effort across teams
- Streamline processes for utilization reviews, appeals, and grievances
- Consolidate member information on authorizations, grievances, appeals, and events in one place for a complete, real-time picture of a member’s utilization activity
6. Tools to identify and address social determinants of health (SDOH)
SDOH have a powerful impact on health outcomes. Some of the platform capabilities already discussed, such as virtual communication tools and automated assessments, are key to identifying and breaking down common SDOH barriers (e.g., lack of transportation, and low health literacy).
But a study published in Health Affairs found that ACOs experienced several specific challenges related to addressing SDOH.
- Exchanging data with community partners, including data on follow-up care and whether members actually used recommended programs
- Securing partnerships with community partners
Look for a medical management platform that can help address these challenges. That means one that offers:
- Integration with community partners for transparency into available resources
- The ability to instantly connect members with community programs and services
- Closed-loop reporting functionality to track members’ progress in using services
Improve members’ health literacy to further close SDOH-related care gaps
Some medical management platforms may also offer integrated health education resources. With education resources at their fingertips, care managers can deliver education when it’s most needed in the way a member will best respond to. VirtualHealth partners with Healthwise and WebMD for example, to give clients the ability to leverage content on medication self-administration techniques, lifestyle modification coaching and encouragement, diabetes, and other topics.
ACOs Should Carefully Select a Care Management Platform
By carefully considering these factors, an ACO can select a care management software solution that supports its care coordination efforts, improves member outcomes, enhances operational efficiency, and meets value-based care goals.