Today, health reform is care delivery reform, payment reform, and health and healthcare community reform combined. Read more on how you can use these three cornerstones to focus on clinical and financial value and outcomes.

1. ACO and Collaborative Care -
The Basics
What you need to know about
Health Reform, Accountable
Care, and Collaborative Care
• Healthcare is changing
• Costs vs. volume
• ACO Benefits
• How to Achieve ACO
HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO

2. Healthcare is changing
Health reform is real and not going
away. People are living longer but not
necessarily healthier. As a result, care is
more costly and inefficient. That’s where
health reform comes in.
Health reform is not any one government or commercial program.
It is not an Accountable Care Organization (ACO), Patient Centered
Medical Home (PCMH), Health Home (HH) or Medical Neighborhood
(MN). Health reform is all of this and more. Health reform is care
delivery reform, payment reform, and health and healthcare
community reform combined.
Health reform is realand
not goingaway.
HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO

3. HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO
These three cornerstones transcend any
one practice model to focus on clinical
and financial value and outcomes.
• Care Delivery Reform – Collaborative care models that blend
organizational, clinical, financial, and technical interventions.
Examples include, but are not limited to, ACO, PCMH, HH, and MN.
• Payment Reform – Economic change in provider reimbursement.
The traditional models of volume-based rewards and who pays
for care are being challenged. Payer innovation is happening that
includes self-insured providers, employers, public and private
insurers, and even patients in new roles.
• Health and Healthcare Community Reform – Traditionally,
healthcare happens at a clinician visit. However, to manage
the overall health of a patient and truly affect outcomes, broad
community engagement is critical. New types of community and
wellness partners are working with clinicians on innovative ways
to improve health.
What is Collaborative Care?
“Its components include patient-centered
care with an orientation toward the
whole person, comprehensive care, care
coordinated across all the elements of
the health system, superb access to care,
and a systems-based approach to quality
and safety.i
”
“Ultimately, these components are
intended to improve patient outcomes—
including better patient experience with
care, improved quality of care (leading to
better health), and reduced costs.ii
”
What is an ACO?
“An organization, virtual or real, that agrees
to take on the responsibility for providing
care for a particular population while
achieving specified quality objectives and
constraining costs.iii
”

4. Cost drivers - value
vs. volume
It is widely acknowledged that the cost
of healthcare will continue to rise. As
healthcare becomes a greater portion of
expenses for employers, public and private
insurers, and even patients, there is an
increasing focus on efficiency and value.
Given this pressure to achieve better value for healthcare, it is safe to
assume that investment will level off and likely begin to decrease over
time. The sooner providers adopt collaborative care models, like ACO
and PCMH, the more likely they are to increase value and not only
share in savings, but share in a greater portion of the system savings.
Achieving results, however, is a multi-year process that requires a
significant investment in time and resources.
Value breeds a new type of healthcare consumer. One that is more
engaged, satisfied, and healthy. Patients and providers with these
characteristics are fundamental to improved outcomes.
HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO

5. Better adherence to treatment recommendations, follow-up, and
prevention are all activities that affect outcomes, but are required of
patients and made easier with engaged providers.
Healthcare value doesn’t come from volume. It is better results
for lower cost, achieved by providers who develop expertise,
reduce errors, increase efficiency, and improve outcomes. Value is,
therefore, an indicator patients can use when choosing where to
get care. To quote Dartmouth’s Elliot Fisher, “The best fence is a
good pasture. If the grass is good, folks will stay with you.” Value has
become competitively relevant not just for justifying savings, but for
maintaining and growing the business.
Public and commercial markets
are deploying new payment
models with value as the
target. Commercial efforts have
already saved millions annually.
CMS actuaries project that
the Medicare Shared Savings
Program could save as much $1
billion over three years, which
is under 0.10 percent of total
Medicare spending.iv
Medicaid
is also launching models in over
five states across the country.v
$
Valuehas become
competitively
relevant
HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO

6. HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO
Gain immediate
access toclinical
information
ACOBenefits

7. Increased
patient engagement
and satisfaction
ACO/Collaborative Care Benefits
for Providers
• Gain immediate access to clinical information
• Improved workflow and care coordination
• Enhanced communication with all members of the
patient’s care team
• Prevent, diagnose, and treat certain diseases or combinations
of conditions, in particular complex cases
• Improved application of evidence-based medicine through
disease management protocols and clinical decision support
• Increased physician and staff job satisfaction by creating a
“hassle-free” clinical practice
ACO/Collaborative Care Benefits
for Patients
• Coordinated care across physician offices and hospitals
• Better health outcomes
• Availability of full medical history accessible by all members
of the care team and in case of emergency
• The end of repeatedly filling out forms on medical history
—and of repeated, unnecessary tests
• Increased patient engagement and satisfaction
HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO

8. HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO
NextGen Healthcare ACO/Collaborative Care Solutions
How to Achieve
ACO/Collaborative Care
Collaborative Care is not any one product or service, it is a concept that is
framed and supported first by proper business planning and then by the
optimal use of organizational, clinical, financial, and technical resources.
Collaborative Care does not come from “out-of-the-box” solutions and is
not “plug-and-play.” It is a very business and staff-intensive concept
that requires knowledgeable staff and expertise.

9. HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO
NextGen Healthcare’s collaborative care experts help providers
reach their collaborative and ACO goals, with services that include:
• Education and Strategic Planning
o Health reform megatrends: The impact they
will have on an organization
o Organizational preparedness and transformation
o New delivery models
o Healthcare policy & regulatory analysis
o Healthcare community partnerships
• Organizational Transformation
o Cultural planning: staffing models, change
management, new models
o Clinical & business transformation
o Application of technology
• Program Assistance
o Funding discovery: matching funding
opportunities to client needs
o Funding-related advice, consulting,
and relationship management
o Funding response writing & planning
o Program execution assistance – based on
specific programs
Learn more. Watch an online demo at www.nextgen.com/ACO

10. HEALTHCARE IS CHANGING COSTS VS. VOLUME ACO BENEFITS HOW TO ACHIEVE ACO
NextGen Healthcare Information Systems, LLC, a wholly owned
subsidiary of Quality Systems, Inc., provides integrated clinical,
financial and connectivity solutions for ambulatory, inpatient, and
dental provider organizations. For more information, please visit
nextgen.com and qsii.com.
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All rights reserved.
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Take the next step.
Contact us at 855-510-6398.
Or email us at EHResults@NextGen.com
Meanwhile, watch an online demo at nextgen.com.
i
See http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__
home/1483/what_is_pcmh_ for AHRQ’s definition of the PCMH.
ii
See Berwick et al. (2008) for a discussion of this “triple aim” of better patient
experience, improved population health, and reduced per capita costs.
iii
“Health Policy Brief: Next Steps for ACOs,” Health Affairs, January 31, 2012.
iv
Meyer, H. Many Accountable Care Organizations Are Now Up and Running,
If Not Off To The Races. Health Aff (Millwood). 2012; 31(11):2363-2367.
v
Burns LR, Pauly MV. Accountable care organizations may have difficulty
avoiding the failures of integrated delivery networks of the 1990s. Health Aff
(Millwood). 2012;31(11):2407–16.
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