|To the rescue!|
And one of the things that ACOs are supposed to do is usher in a new era of evidence-based medicine. The DMCB has its doubts about that too (more on that below), but for something completely different, check out this JAMA Commentary by Dario Giugliano and Katherine Esposito on "clinical inertia." It turns out that there are a number of peer-reviewed diabetes, hypertension and cholesterol studies that cast doubt on the wisdom of striving for universally low A1cs, systolic blood pressures and LDLs. While our leaders tut-tut the medical establishment's failure to achieve 100% compliance with academic-expert opinion (or its benefactors), Drs. Guigliano and Esposito wonder if some physicians could have a very reasonable doubt about the evidence or may be reacting with justifiable uncertainty. If they're right, clinical inertia may be more of a patient safeguard than generally appreciated.
Yet, while the DMCB is being an ACO weenie, that hasn't stopped it from trying to be of help. That's why it participated in the development of this Care Continuum Alliance "toolkit" titled "Achieving Accountable Care: Essential Population Health Management Tools for ACOs." You can download this expertly edited and heavily referenced review here.
In the toolkit, readers will be able to learn about the many other interventions necessary to successfully manage that all important "attributed" population. That includes using health risk assessments (HRAs), taking full advantage of risk stratification (predictive modeling), maximizing patient enrollment in clinical programs, putting clinical guidelines into perspective with targeted decision support and shared decision making (the answer to the conundrum described above), leveraging nurse-led care management programs, really taking advantage of health information technology, measuring everything and working with third parties to build programs. Do all these things, says the DMCB, and your ACO will have a much better shot at making a real difference. It might even make some money.
As a reminder, the DMCB will be discussing this more fully in a CCA hosted webinar later this week. Registration info here.