Addressing patients’ nonmedical needs—those that are not clinical in nature but have the potential to affect health—is a step that has been shown to benefit health outcomes. A new study indicates that many accountable care organizations (ACOs) are finding ways to help their patients overcome these obstacles to achieving better health. 

Researchers conducted telephone interviews with 58 executives at 32 ACOs and made site visits to three of the ACOs to find out whether the organizations were addressing nonmedical needs, and if so, which ones, and what approaches they were using.

Sixteen of the ACOs were taking steps to address nonmedical needs, most commonly transportation, housing and food insecurity. Some ACOs were using individualized solutions developed one patient at a time, whereas others had taken a more targeted approach by implementing formalized programs for specific needs.

Most of the 16 ACOs coordinated with other types of providers such as public health agencies, community health resources and social service agencies to improve patient care. Two ACOs had integrated nonmedical needs-related programs and services into their operations to such an extent that they had representatives of nonmedical providers or agencies on their board of directors. 

Patients with nonmedical needs were identified through processes in the primary care visit or by analyzing hospital utilization patterns.

Among the barriers the ACOs cited to addressing nonmedical needs were inadequate financial resources, limited staff, lack of expertise and competing clinical priorities.

The research was published in the November issue of Health Affairs. 

Our Take: Nonmedical home care—commonly referred to as “private duty” home care—has largely been excluded from the value-based care conversation, in large part because it has earned, rightly or not, the unfortunate labels “nonmedical” and “unskilled.” Yet for several years we’ve been urging CEOs in this sector to partner with ACOs and integrated health systems. The value proposition is too strong to ignore.

But in reality, these conversations often fall on deaf ears, for several reasons. For one, the idea is far outside their business model, which depends upon individual referrals on a case-by-case basis from friends and family, physicians, financial planner, hospital discharge planners and others. Second, these firms by and large are averse to taking on risk, although having a contracted business with an ACO doesn’t necessarily mean going at-risk. Third, most companies that provide in-home personal care services aren’t collecting the data to prove their worth—think readmission rate reduction—although for some firms that is changing.

We just completed our 3rd annual ACO Executive survey, the results of which will be a chapter in our 2017 ACO Outlook. Of the 79 ACO executives who completed the survey, about one in ten have an existing contract with a private duty home care company, and another 15 percent are in talks right now. That highlights a final reason for why we don’t see a lot of preventive home-based care deals with ACOs: It’s not high enough on their radar. Not yet, at least.

Southern California-based 24Hr HomeCare is an example of one company that sees partnerships as a primary growth strategy. They’ve contracted with Greater Newport Physicians (GNP), an independent practice association of about 900 affiliated physicians. Because GNP absorbs the cost of readmissions for the patients it serves, it has a financial interest in preventing readmissions. 24Hr HomeCare provides services to this set of high-risk patients at a discount from their usual rate. Their internal data suggest that their readmission rates are less than half that of the average ACO.

Among other deals like the aforementioned, 24Hr HomeCare is also contracted with HealthSouth to provide care to patients within their Bundled Payment program with CMS. They aren’t at risk in this agreement either, but spending is capped.

The article in Health Affairs highlights barriers to nonmedical interventions, and private duty companies can eliminate three out of fourlimited staff, lack of expertise and competing clinical priorities. Private duty CEOs should see this as an opportunity, or a least another positive data point, for having a conversation with ACOs.

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