The Office of Inspector General (OIG) recently reported on key tactics shared by the top 20 ACOs who are returning savings to Medicare under the Medicare Shared Savings Program.
• Work with doctors to let them know what their services and decisions cost
• Wherever possible, reduce the administrative burden on the providers to participate
• Provide data to doctors about their practices and referrals to increase awareness of cost and reveal gaps in care (and educate physicians with unusual spending or utilization)
• Encourage patients – especially those with costly chronic conditions – to get involved in their own healthcare
• Help patients avoid unnecessary hospital and ER visits by coordinating their transitions of care and promoting annual wellness visits
• Share data between providers, across EMRs or by having all providers on a single EMR
• Explicitly address patients’ behavioral health and unmet social needs
As you can see, many if not most of these tactics are supported by having a referral management structure in place to facilitate provider engagement, share clinical data across EMRs and engage the patient to make sure they follow through.