An accountable care organization can transform how care is delivered and prioritize new approaches to population health and primary care. We recently had a conversation with one of our ACO physician leaders, Dr. Divya Sharma, Chief Medical Officer for the Central Oregon Independent Practice Association in Bend, Oregon, about the most important lessons learned from joining an accountable care organization. 

What are the biggest takeaways from your experience in accountable care? 

Dr. Sharma: One of our biggest challenges is, for this important work, how does it pay for itself? How you prioritize which model you want to pursue all depends on the resources that you have in the community, what your need is within your own organization and what kind of contract can support each one all make up the basis for decision-making.  

It's nice to see that CMS is moving towards greater emphasis on behavioral health integration, and I'm excited to see hopefully the payments aligning to support that good work. As providers, we recognize how important behavioral health integration is, not only for better care of patients, but also well-being for our clinical caregivers.  

What are some of the biggest obstacles that organizations face in trying to provide coordinated care to patients with complex chronic conditions?  

Dr. Sharma: The biggest obstacle in providing good care for the most complex patients is with payment. Our payment structures are still much more siloed, while the delivery is expected to be much more integrated. Another challenge is that more and more is being asked of our primary care practitioners. This makes some sense because primary care is the gateway – the front door – for most of the things that affect and impact a patient's well-being and care. But the medical providers are not necessarily the most equipped to be able to address those issues, such as ancillary support services.  Our payments still lag behind what's needed to be able to do it in an effective manner that truly does provide the care and can move the dial much faster than these little piecemeal things that we're trying to put together and then build upon.  

How do you make the case to physicians and clinics that they should join an ACO? 

Dr. Sharma: One of the biggest values that the organizations get from joining an ACO is getting data on a subset of their population, which is this incredibly complex population that we really don't know how we're managing. Once we get data, we can look for opportunities to minimize waste and provide better care. In the early phase, there is some low-hanging fruit, but then as we maximize that, we can move to other areas of opportunity where we really can cut costs or shift costs towards higher value care. First and foremost, that is the number one benefit of joining an ACO.  

The second benefit is that, for some organizations, this is just their first step into thinking about value-based care delivery and thinking about population health in a much more robust way. By joining an ACO, you've got tools and you've got resources and a community to tap into for expertise. That’s another real value of being able to join an ACO.  

What did you learn from attending the Caravan Health Accountable Care Symposium? 

Dr. Sharma: This has been a great opportunity for peer-to-peer learning, to share our experience with other organizations, and to learn from what other organizations have tried. It’s clear that there are many different ways to get at the same outcomes. We continue to learn, again, from what will work for each organization and how to ask the right questions. The Caravan Compass platform helps us look at opportunities and look at data so we can figure out what questions we want to ask. The platform helps us set up our dashboards to get the data that we need to answer those questions and continue to make progress in doing a better job taking care of our patients. 

Interested in learning more? View our webinar about the mechanics of ACOs:


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