Accountable Care and PCMH

Successful Accountable Care Organizations (ACO) and Patient Centered Medical Homes (PCMH) have a few characteristics in common. They all have the ability to innovate rapidly, evaluate potential opportunities, and act quickly in the best interest of both the patient and the organization. They understand who is in their attributed population, what their needs are, and how they need to modify their operations in order to meet them.

In order to do to improve clinical outcomes while also reducing the cost of care, healthcare delivery networks (HDNs) need to be able to:

Evaluate potential interventions based on their clinical and financial impacts
Compare treatment options for both clinical and non-clinical efficacy
Consider how social and economic factors impact the needs of the patient population
Identify opportunities to expand into under-served markets
Build a strong business case for wellness and prevention programs

SIMUL8 users have been using simulation as a tool for evaluating potential scenarios, testing hypotheses, and negotiating better contracts with payors.

Scenario Generator

SIMUL8's Scenario Generator is the only simulation software tool for strategic planning that can predict population health, costs and capacity utilization.

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Identify the Needs of the Attributed Population

To ensure financial sustainability, ACOs and PCMHs are focused on serving the needs of their attributed population in order to improve health outcomes and reduce the cost of care. These health delivery networks need to understand how demand will change over time based on changes in disease prevalence, treatment options, and local population factors.

The first step in this effort is to determine who is considered attributed to the organization, usually based on recent primary care or general practitioner visits. Once that is done, the disease prevalence and current health status of these patients is examined, in order to determine where there may be gaps in care and opportunity for improvement. These become the target areas for interventions, process changes, and protocol updates.

For organizations looking for growth, this is also an opportunity to identify current strengths or excess capacity that could be better utilized by growing the number of patient lives included in the attributed population. This may be geographic in nature, such as a specific neighborhood in the community, or clinical in nature, such as poor diabetes management in patients with multiple co-morbidities.

There are many ideas about what needs to be done in order to improve clinical outcomes, increase patient satisfaction, and reduce the cost of care. It is critically important to understand how these potential interventions will impact the HDN and to consider local factors that may influence these outcomes.

Simulation is commonly used to evaluate interventions in order to make the most of limited funding:

Which interventions will be the most effective clinically?

How do unique local factors affect the likelihood of success?

What are the risks of potential overlap and/or interference between interventions?

Consider Social and Economic Factors

After identifying a need in your community, the next question is how do you reach the patient population? This can be especially difficult if the patients are socially or economically disadvantaged, such as those without stable family support, those experiencing economic hardship, or patients without adequate insurance coverage.

Social and economic factors are some of the most difficult to factor into an evaluation. For example, one hospital used simulation to examine its maternity unit and to develop creative solutions to overcome the social and economic factors that were causing issues with patient access.

Capacity Planning

Once the decision is made to implement a new procedure, process, or service offering, the next step is to examine your capacity needs. This allows you to:

Predict patient volume growth
Assess the impact on patient delays and capacity utilization
Identify additional capacity needs proactively

Wellness and Prevention

Finally, the crucial success factor is to ensure that your organization is compensated appropriately for the value that you are creating, both in improved outcomes for patients and also reduced cost of chronic, long-term, and acute medical care. Simulation is the most effective way to demonstrate to your patients, community, and payors how much your organization has been able to accomplish.

Learn More About Simulation for ACO and PCMH

Simulating Mount Sinai's Maternity Unit

Mount Sinai Hospital used simulation to examine its maternity care pathway and understand the impact of extending antenatal care to all potential patients, thereby preventing complications at a later stage in the pregnancy.

Using Scenario Generator, Mount Sinai Hospital was able to model maternity services looking at a number of scenarios surrounding insured vs. uninsured women and the impact of service changes on patient care, bed capacity and cost.

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Improving Patient Care Pathways

This webinar looks at patient care pathways and demonstrates how simulation can combine process flow perspectives to include; services, clinical best practice, and the progression of patients through disease states to test the impact of improvement initiatives on patient care, outcomes, costs and resource utilization.

Using examples from recent projects on simulating care pathways within HIV services, and simulating future service needs for dementia care, we show the results of combining disease progression with service utilization.

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Using SIMUL8 to inform decision-making on National Bowel Screening

Maasstad Hospital used SIMUL8 to test multiple scenarios and determine possible outcomes which would influence its decision to join the National Bowel Screening program.

Using SIMUL8, Maasstad Hospital had the knowledge to implement the most effective method of performing BVO Colon screenings and know the impact this would have on their normal colon screening patients.