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Accountable Care Organizations: Choose this Mindful Approach to Healthcare Spending

Published 12/16/2020


There’s a lot of talk about being mindful of the choices in our daily lives and in how we treat ourselves and others. It’s the topic of social media posts and memes, self-help books, and even television programming.

Mindfulness is key in the development of an accountable care organization (ACO) and determines future success in delivering quality, satisfaction, and value to patients and employer groups. Successful ACOs, like Kelsey-Seybold Clinic, are mindfully committed to working with employer groups – and their members – to offer evidence-based healthcare solutions focused on prevention and chronic disease management.

Accountable care organizations develop programs and services to help keep members healthy – and direct the flow of care toward appropriate intervention and prevention. Care is shifted away from needless or redundant treatments and testing. ACOs also benefit the patient and employer by managing the rising costs of care.

How does mindfulness impact the results of our ACO in day-to-day patient care – and why?

The “why” is easy – this is the way physicians want to practice medicine. And when the focus of patient care shifts from fee-for-service (FFS) billing to redirecting those resources to clinical programs that benefit patients – such as Virtual Health, Disease Management, and other ACO-based programs – an intentional and mindful shift in utilization happens.

A Cultural Shift

ACOs provide patient-centered care by developing a culture that is collectively and mindfully focused on quality, satisfaction, and value. For Kelsey-Seybold, that model of care represents the “Triple Aim,” of better quality, better experience, and better value, which underlies every medical decision and organizational strategy.

ACOs empower physicians to practice evidence-based medicine, resulting in a real and dramatic shift from “reactive care” to “proactive care” to help keep patients healthier. The result of this alignment to the Triple Aim is more satisfied patients and reduced healthcare costs.

Laser Focus on Prevention

If a hospital stay is never necessary because doctors and patients work together to prevent the need for acute care, how much could that save an employer? Managing chronic conditions before they result in complications requiring hospital stays, or addressing the failure of care delivery, can result in more than $97 billion in savings each year in the United States, according to the Journal of the American Medical Association1. And groups like Kelsey-Seybold Clinic focus on prevention and the management of chronic conditions because it’s less costly and simply better patient care.

At Kelsey-Seybold Clinic, advancements in technology have allowed us to develop a robust Virtual Health offering, including Video Visits and e-Visits, and also enabled the Clinic to embrace an electronic medical record (EMR) system:

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When patients find themselves circulating back and forth between home and the hospital, they are automatically queued for evaluation by the Population Health team to help assess individual needs in their home environment. It’s a program that strives to improve patient health and engage with healthcare providers in an effort to resolve medical issues resulting in ER and hospital visits.

Data Steers the Ship

In the end, when mindful prevention is the goal of the patient and the healthcare provider, the benefits are easy to realize. Based on our decade-long track record of evaluating our value-based plan, we know that our commitment to the Triple Aim has helped us maintain lower utilization rates for Admits per 1,000 (34%), ER visits per 1,000 (32%), and Catastrophic Claims per 1,000 (62%).

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The solution for employers concerned about healthcare costs is to find a plan option that actively seeks to provide value right within its model of care. To today’s employers, healthcare costs may seem mindlessly out of control. Adding a value-based ACO plan like Kelsey-Seybold’s to your list of benefit offerings is a way to strike a mindful balance between value, employee satisfaction, and care quality.


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Author

Kenneth Janis, MHA, MBA,

Chief Operating Officer (COO)