Affordable Care Organization Case Study

Accountable Care Organizations (ACOs) like any other organization need funding. Organizations cannot function without financing. They must be funded in some way to continue operation to support employees and practice. ACOs can be funded in two different ways, internally or externally. This means funding is coming from the organization itself or from an outside investment.

According to Shi and Singh an accountable care organization, also known as an ACO, describes an integrated group of providers who are willing and able to take responsibility for improving the overall health status, care efficiency, and satisfaction with care for a defined population. The ACO was established by the Patient Protection and Affordable Care Act (PPACA) Section 3022 mainly to better the quality of care to beneficiaries and to save money for Medicare (Golden). The accountable care organization is voluntary for provider participation and Medicare beneficiaries still can choose treatment from any provider they wish which is beneficial. The ACO has been viewed as a potential tool for rebuilding the traditional Medicare coverage according to Medicare Payment Advisory Commission known as MedPAC (Rosenbaum). According to CMS,

As the continued support grows the PCPCC, the health care sector is recognizing the role of the medical home model, Accountable Care Organizations(ACO), many entities are embracing the model and performing better. According to Center of Medicare and Medicaid, the medical home model shows that there is an improvement cost effectiveness, which helps practitioners deliver quality care and advanced approaches to care coordination, care teams, and chronic disease management. As evaluations of ACOs, integrated health systems, and the medical neighborhood continue, the Patient Center Medical Home will be essential to driving improvements in cost, quality, and outcomes. [3]

The Accountable Care Collaborative is Health First Colorado’s program that is the primary resource to provide enhanced coordinated care. The three primary goals of the ACC program are to better health, improve the experience of both the providers and the ACC members, and to contain costs. The ACC connects primary care medical providers (PCMPs), the statewide data and analytics contractor (SDAC) and the Regional Care Collaborative Organizations

Large hospitals have chosen to become ACO providers. Accountable Care Organization (ACO) which are of doctors, hospitals and other healthcare providers, which come together voluntarily to give coordinated high quality care to the Medicare patients they serve.

​Kaiser Health News recently published an article on a new trend in healthcare. This trend introduces the Accountable Care Organization (ACO). The Centers for Medicare and Medicaid services defines it as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (“Accountable Care Organization,” 2015). According to the Affordable Care Act (ACA), the goal of the ACO is to be able to share health cost-savings with providers who are able to save money by eliminating unnecessary procedures and reduce health costs while increasing quality of care. ACOs make health professionals become more accountable in maintaining good-quality, coordinated healthcare for a patient through a value-based system that is evaluated through a number of criteria and benchmarks (Ronai, 2011).

Based on an article written in the Journal of Health Policy, Politics and Law to increase the value and quality of health care services provided to Medicare patients there is a need for health care professionals to focus more on working as a team to coordinate care. The purpose of establishing an ACO is to achieve high quality outcomes in the most effective manner. By establishing an effective ACO would provide benefits to patients and health care professionals within the community. By accepting the government’s offer will allow patient care to improve, decrease health care expenses and will overall benefit the health care providers within the organization.

The American health care system has been victim to an escalation in the prices of health care services juxtaposed with inefficiency in delivery of care services. There has even been cases where State spending on the actual health care increased dramatically in the United States and one of the key components of curbing this problem which has been prevalent over the mass media and has been a major discussion among physicians is the advent of Accountable Care Organizations. Accountable Care Organizations (ACOs) is structured with the goal of trying to improve health care delivery and aid in the reduction of the overall cost of services (Weissert & Weissert, 2012). If there is insufficient coordination of high quality care delivery in the health care industry, this will have a negative impact on patient safety and diminish affordable care for patients. Hence, the development of ACOs is envisioned to be the savior of medical practices and can improve the overall fabric of the American society (Bresnick, 2013). ACOs serves as one of the answers for curbing the problem of high costs, low quality care and possible segmented delivery and as much as it serve as the major determinant for improvement in patient satisfaction, there are minor

Pioneering an Accountable Care Organization Model which is a program which goes hand in hand with the Medicaid Shared Savings Program. They are focused on providing highly coordinated care for Medicare fee-for-service-beneficiaries.

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

The cost of running a system supported by government resources is too costly, and it will not help the deficit. The organizations responsibility for the regulatory practices of the ACO with the best method to improve quality and greater collaboration of care providers that will reduce cost. Unavoidably, the infrastructure would result with consolidation, coordination in the sector of health care. The Department of Justice and the Federal Trade Commission

Accountable Care Organizations (ACOs) are group of physicians, hospitals and other healthcare providers coming together voluntarily to deliver high quality healthcare to patients. On the other hand, American Hospital Association (2010) defines ACO as legally structured arrangements between hospitals, specialty physicians and/or primary care and other healthcare providers to facilitate effective and efficient healthcare for a defined patient population. Typically, ACO focuses on assisting patients with chronic disease to get right care at the right time with overall goals of preventing medical errors and unnecessary duplication of healthcare services. More importantly, ACO focuses on delivering high quality healthcare at low costs. The Health and Human Service (HHS) estimates that ACO could assist Medicare to save more than $960 Million in the first three years, which will assist Medicare to spend healthcare dollars more wisely. (Centers for Medicare & Medicaid Services.2012).

The first ACO model started January 1, 2012 and consisted of 32 ACOs with 860,000 beneficiaries (CMS, 2016). ACOs are made up of groups of hospital, doctors, and other health care providers who provide coordinated high quality care to their patients. The goal of this coordinated care is to ensure patients receive the appropriate care in a timely manner while avoiding unnecessary services and duplication of services. The expected end result is the delivery of high quality care and reduction of health care cost and the incentive for the health care provider to meet the goal is the share of the savings they will receive. As stated by Dr. Berwick, (Its (ACOs) purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care” (Berwick, 2011). The ACO providers are held responsible for meeting quality improvement measures while reducing their rate of spending.

The trend called healthcare reform is not something that is new to the healthcare industry. Healthcare has been progressing in this direction since 1932, when the Committee on the Costs of Medical Care reported a proposal to “integrate practice of medicine rather than autonomous individual set of practices” (Kirschner, p. 3). By definition, an Accountable Care Organization (ACO) is “a legal entity composed of a group of providers that assumes responsibility (are accountable) to manage and coordinate care for a defined group of patients in an effective (high quality) and efficient (low cost) manner” (Kirschner, p. 2). Therefore, as health information management (HIM) professionals, we must focus on whether or not ACO’s can truly provide this

The ACOs major goal is making practitioners take responsibility of patient health care outcomes and reduce spending (Matthew et al., 2011). Furthermore, the participants that make a decision to join the ACO will be given incentives to help improve the quality of healthcare, and decrease unnecessary test and treatments (Matthew et al., 2011), in other words, it will regulate spending.