ACO Development and Implementation

ACO Development and Implementation

Veralon has extensive experience in helping health systems and hospitals with Medicare ACOs and similar ACO development and implementation, as well as in optimizing performance of existing ACOs. We have also helped develop some of the now more mature and successful payer and risk-contracting organizations.

Veralon can help your organization in all aspects of ACO development, implementation, or optimization, from strategy and organizational readiness, to financial and operational development, to infrastructure assessment.

Check out Quanto, a powerful web-based tool to help you manage your ACO Financial Performance!

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ACO Development

Veralon provides the strategic and feasibility analysis required to evaluate launching an ACO, assuring that if and when the organization moves to detailed development planning, it will be a productive investment. We address:

  • Investment requirements
  • Risk and return
  • Shared savings, timing and division
  • Engaging both independent and employed physicians
  • ACO impacts on volumes and revenues, whether from your own ACO or another that might emerge in the market
  • Which ACO model to pursue
  • Whether the transformations generated by a Medicare ACO will create opportunities for contracting with health plans or self-insured employers

Many organizations have CINs, PHOs or other organizational structures that can support ACO development. The first step in creating an ACO strategy is to assess how the organization’s existing capabilities relate to the organizational, clinical integration and care management requirements for an ACO. If your organization needs to develop a structure, we can assist with that as well (see CIN Development)

ACO Implementation                                                          

Once you have made the decision to move ahead, Veralon can assist with detailed preparation including developing an organizational structure if required, planning for quality management and operations, and financial structure and modeling.

  • Identifying opportunities to redesign clinical care and better manage your population
  • Developing approaches to monitoring performance, using a mixture of standard reports and customized solutions
  • Maximizing contracting effectiveness, by monitoring the financial performance of your ACO contracts and positioning you to retrieve money being left on the table
  • Designing incentive models that emphasize care goals, teamwork, and individual contributions
  • Understanding the system impact—financial impact on all system and partner entities

ACO Optimization

If you need to improve the performance of your existing ACO, or prepare to take on risk, Veralon can help you achieve the best performance possible. We use Quanto, as applicable, to analyze performance and identify opportunities for improvement. The work includes:

  • Assessing trends in cost and utilization such as:
    • Care location
    • Diagnosis and procedure
    • Physician
    • Post-acute care provider
    • Sequence of care
  • Looking at in-and-out of network leakage, avoidable admissions, and readmissions, by categories above and others, as appropriate
  • Identifying high-cost and high-risk beneficiaries to target care management initiatives
  • Assessing and making recommendations for strengthening infrastructure
  • Engaging physicians to drive improved results, including development of customized report cards
  • Identifying and designing performance improvement initiatives and modeling potential impact

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