Using Evidence-Based Care Guidelines for ACO Success

Accountable care organizations (ACOs) have a lot to gain from establishing and using evidence-based care guidelines. According to an NCBI article, clinical guidelines have the potential to enhance provider decisions, guide clinician practices, and provide a consistent quality of care for patients. 

From a payer’s standpoint, evidence-based care guidelines can ensure more cohesive decisions and consistent quality of care from providers. This means that ACOs with the right guidelines can establish effective protocols that can ultimately reduce unnecessary healthcare costs—not to mention more savings and better patient outcomes!

Benefits of Integrated Evidence-Based Care Guidelines

From an ACO’s perspective, integrated evidence-based care guidelines bring a lot to the table. For example, having standardized processes can help providers, clinicians, and staff members in your network make better decisions. 

Whether it’s for diagnosing patients or processing claims, having a comprehensive set of guidelines can help your network take better action, better care, and generate better outcomes. Read our list of the top three benefits that ACOs can get from applying integrated evidence-based care guidelines into their system.

1. Ensure Quality Standards for Patient Care

Delivering a consistent quality of care to your patients is key to maintaining success, especially in a value-based payment model. You want your network of providers to be on the same page and deliver the same quality of care to their patients. For example, patients with similar conditions could require varying amounts of medical care because of varying provider decisions. This could result in one patient having more medical expenses which could have been easily avoided.

By implementing integrated evidence-based care guidelines, your providers can ensure that most, if not all of their patients, receive the right medical services accordingly. As a result, you can avoid unnecessary expenses that come from different provider decisions. This could also improve the consistency of care for the different levels of care that patients go through.

2. Reduce Waste and Inefficiency

As mentioned above, integrating evidence-based care guidelines means setting a standard of care for your patient population. Empowering your providers and clinicians to provide cohesive clinical decisions leads to more accurate treatments. In other words, you can reduce redundant services and expenses by simply allowing your providers to follow a set of guidelines when it comes to dealing with patients.

Reducing waste and inefficiency through care guidelines allows ACOs to better manage their patient population at different levels of care. Additionally, this also allows payers to funnel their patients towards a more cost-efficient care path without reducing the quality of care. When done correctly, these evidence-based care guidelines could enhance your cost reduction, savings, patient care, and benchmark scores.

3. Enhance Communication Between Patient and Provider

In a value-based environment, coordination between providers and patients should never be compromised. Good care coordination between all parties in the healthcare environment is the backbone of any ACO success. After all, ensuring quality care at minimal expenses is hard to accomplish without the right care coordination. 

You can enhance and even solidify your network coordination by simply integrating evidence-based care guidelines into your operations. Having a cohesive template that your providers can follow can help put them on the same page. And when your network functions cohesively, care teams and clinicians can deliver the right services in a more efficient manner—no more redundant tests, screenings, and treatments. Put simply, ACOs can simplify how their network communicates by giving the right guidelines for everyone to follow.

Final Thoughts

Evidence-based care guidelines can potentially enhance your overall outcomes; however, its success still relies heavily on your strategy. Like any business strategy, your care guidelines will only be as effective as its implementation. In other words, you need to make sure that you take the right steps in informing, educating, and training your network with these processes.

Additionally, you can also increase the effectiveness of your guidelines by making them easily accessible. When your providers and administrative staff have instant access to your guidelines, they can make better decisions and comply with your protocol.

Finally, it is also beneficial to integrate your care guidelines with your existing management system. Doing so will allow you to easily update and inform your staff with the right guidelines at a moment’s notice. In addition, having integrated evidence-based care guidelines in your system allows your network to access the right guide with a click of a button.

QuickCap 7’s Integrated Evidence-Based Care Guidelines

QC7 comes with a fully integrated set of Milliman Care Guidelines (MCG) and Apollo Managed Care Guidelines (AMC) that your team can access instantly. As a result, you won’t have to worry about finding a third-party solution for all your care guideline needs. Additionally, QC7 allows you to do the following:

Easily upload essential documents for your teams and network to review.

Make team-specific guidelines accessible for everyone who needs it.

Utilize built-in code guidelines to ensure accurate authorization, claims, and payment processing.

QC7 has all the right tools that cater to all your ACO-specific requirements. Put simply, QC7 is a powerful system that allows you to solve management challenges with a single, flexible solution.