What is the ACO Primary Care Flex model?
Primary care is the foundation of a well-functioning healthcare system. It serves as an important initial point of contact for patients, with the goal of delivering evidence-based, person-centered care. Access to high-quality primary care strengthens preventive health services and screenings and can lead to improved health outcomes, including reduced mortality rates, reduced health disparities, better disease management, and improved chronic condition outcomes. However, challenges such as staffing shortages and the rising demand for care underscore the urgent need for new approaches to the way care is delivered that lean specifically on primary care. While accountable care organizations (ACOs) have emerged as a solution to these challenges, their ability to support primary care has been limited by the traditional fee-for-service system.
That’s why the ACO Primary Care Flex model was created. It starts January 1, 2025, and aims to increase primary care provider (PCP) participation in ACOs and the Shared Savings Program, as well as to increase the number of people with Medicare in an accountable care relationship. This model reimagines the role of PCPs within ACOs.
Let’s take a deeper dive into what the ACO Primary Care Flex model entails and why it’s important to providers.
What is the ACO Primary Care Flex model?
The ACO Primary Care Flex model is an alternative payment model designed to empower primary care providers (PCPs) to take a leading role in care coordination and quality improvement. This model builds on the foundation of traditional ACOs by emphasizing the critical role of primary care in improving patient outcomes and reducing healthcare costs.
Key features of the ACO Primary Care Flex model include:
- Enhanced care coordination: PCPs serve as the central point of contact for patients, coordinating their care across various specialties and settings. This streamlined approach ensures continuity of care and reduces unnecessary healthcare utilization.
- Value-based incentives: Unlike the fee-for-service, the ACO Primary Care Flex model incentivizes value-based care and rewards providers for delivering high-quality care that leads to better patient outcomes and cost savings.
- Data-driven decision-making: The model emphasizes the importance of data to inform decision-making, allowing providers to identify high-risk patients, track performance metrics, and implement targeted interventions for improved care delivery.
- Patient engagement: ACOs under this model prioritize patient engagement and shared decision-making, empowering patients to actively participate in their healthcare journey and achieve better health outcomes.
- Quality improvement initiatives: Providers participating in the ACO Primary Care Flex model are expected to prioritize quality reporting and performance improvement activities, driving continuous enhancements in care delivery and patient experience.
Why is the ACO Primary Care Flex model important?
The ACO Primary Care Flex model is important because it focuses on the role of primary care in streamlining care coordination (leading to improved patient experiences) and facilitating better patient outcomes through value-based incentives and data-driven practices. Additionally, its emphasis on cost savings and sustainability benefits PCPs by reducing unnecessary spending. Moreover, the model’s focus on patient-centered care and collaboration reduces provider burnout and enhances communication with care teams, ultimately leading to improved quality of care.
How WellSky can help primary care providers
There are many ways in which WellSky can help primary care providers find success in the ACO Primary Flex Model.
- Streamline care coordination
With WellSky, PCPs can connect to the most complete care coordination network of acute, post-acute, home and community-based providers to address gaps in care and intervene, when necessary, as patients transition through the continuum of care. WellSky solutions give providers the ability to communicate electronically with other providers about their patients, receive and respond to referrals quicker, and seamlessly share higher quality providers with acute discharge planners.
- Reduce post-acute spend
According to a recent WellSky survey of physician leaders, 78% of respondents are concerned with their post-acute spending. WellSky generates value and controls costs across the care continuum — helping providers reduce length of stay and readmissions, divert patients from the emergency department, and find success with Transitional Care Management. With WellSky solutions, providers can efficiently manage a patient’s total cost of care by influencing care transitions from the hospital to a higher performing post-acute network.
- Deliver intelligent patient-centered care
Providers leveraging WellSky receive more than just a real-time notification for any admission or discharge from both acute and post-acute facilities. With WellSky solutions, providers gain visibility into real-time data, like readmission risk, utilization history, and prioritization of their patient panel. WellSky helps ACOs succeed in value-based care programs by efficiently addressing gaps in care and necessary interventions as patients with complex needs transition through the continuum of care.
Taking it a step further, the WellSky Activate solution equips acute partners with vital program or benefit information at the patient’s bedside to help drive hospital workflows and improve patient engagement before the patient moves to the next level of care.
- Improve care quality
Primary care can play a vital role in helping patients transition to high-performing post-acute providers, which is a vital component of success in value-based care. WellSky analyzes post-acute provider performance, helping providers build and manage post-acute care collaborations and ensure patients receive the best care possible.
The ACO Primary Care Flex model represents an important step towards achieving value-based, patient-centered care. By redefining the role of primary care, leveraging data-driven insights, and prioritizing collaboration, this model has the potential to drive meaningful improvements in healthcare quality, outcomes, and sustainability.
Learn more about how WellSky is helping primary care providers lower costs and improve patient outcomes with increased visibility and collaboration.