Accountable Care Organizations
In the past few years the American health care system has changed in many ways. First there was the passage of the Affordable Care Act, which is a law that is giving Americans the opportunity to obtain health care. Under this new law, in 2011, the Department of Health and Human Services decided to create Accountable Care Organizations (ACO) to help doctors, hospitals and other providers better coordinate care (AthenaHealth.com). The first idea of an Accountable Care Organization was brought up in 2006 by Elliot Fisher, MD, and now there are over 400 in the United States (Healthcatalyst.com). An ACO’s primary job is to improve health care delivery, performance, and payment. This is done through physicians and
…show more content…
One of these examples is the Meridian Health Accountable Care Organization. “In January 2013, Meridian was selected by the Centers for Medicare &Medicaid Services (CMS) to participate as a Medicare Accountable Care Organization (Meridianhealth.com). When a system is selected to become an Accountable Care Organization it can choose one of three routes. They are Medicare Shared Savings Program, Advanced Payment ACO Model, and Pioneer ACO Model. Meridian Health chose the shared savings program. This program goals include better care for individuals, better health for populations and lowering growth in expenditures. The Shared savings program also rewards “ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first” (CMS.gov). The next type of ACO is the Advanced Payment Model. This model is “designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patient they serve… selected participants will receive upfront monthly payments”(CMS.gov). This form of ACO is for systems that do not meet the requirements for Shared Savings because they are too small in size and they do not have access to capital so that they can invest in upgrading their system. So far there are 35 ACO using this model and so that they can
CMS defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” The goal of coordinated care is, “to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary
The Accountable Care Organization (ACOs) is in an integration of doctors, hospitals and other health care providers to deliver efficient care. The purpose is to ensure that patients get the best health care treatment and prevent any medical errors. Public and private payers are part of the accountable care organizations for people that use Medicare or non-Medicare users. The essential components of ACOs are to reduce cost and share savings, remove existing barriers to improve the value of care, and have a payment system that rewards the volume and intensity of provided services. Furthermore, ACOs goals are to develop legal agreements between hospitals and other providers
ACO, another 3 letter health care organization consisting of integrated groups of providers, comes along promising the elusive goal of reducing health care cost, improving population health, and bolstering custom satisfaction. Sounds like a perpetual remake of a 70s movie called HMO that went through several reiterations over the past decades which gave us PPO, PSO, IDS, and the different flavors of MCOs. ACO’s hype is credited to the Affordable Care Act as it sought to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Bottom line, providers are promised to make more if they
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 concept of an Affordable accountable cCare oOrganization (ACO) is still evolving. Generally, an ACO is a group of health care providers (including primary care physicians, specialists, and medical facilities) that work in partnership and are collectively accountable for the cost and quality of health care they deliver to a specific population of patients. At the heart of each patient's care is a primary care physician.
An Accountable Care Organization or ACO is a group of doctors, hospitals, and healthcare providers, who voluntarily come together and provide coordinated high quality medical care to Medicare patients.
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
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 Affordable Care Act (ACA) legislated in 2010, has changed the United States health care industry. In addition to universal healthcare, one of the principles of the ACA is the ideal of accountable care. Specifically, adopting an Accountable Care organization (ACO) for Medicare beneficiaries under the fee for service program. An ACO seeks to hold providers and health organizations accountable for not only the quality of health care they provide to a population, but also keeping the cost of care down (1). This is accomplished by offering financial incentives to the healthcare providers that cooperate in, circumventing avoidable tests and procedures. The ACO model, seeks to remove present obstacles to refining the value of care, including a payment system that rewards the volume and intensity of provided services instead of quality and cost performance and commonly held assumptions that more medical care is equivalent to higher quality care (2) .A successful ACO model, will have developed quality clinical work and continual improvement while effectively managing costs, however this is contingent upon its ability to encourage hospitals, physicians, post-acute care facilities, and other providers involved to form connections that aid in coordination of care delivery throughout different settings and groups, and evaluate data on costs and outcomes(3). This establishes the ACO will need to have organizational aptitude to institute an administrative body to manage patient care,
Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care
In this paper you are going to learn all about the Accountable Care Organization (ACO). Also, how does it pertain to the healthcare system? We will also be learning about the reimbursement rates for Medicare patients. Who makes up the Accountable Care Organization? We will also take a look into the Affordable Care Act and how the ACO is a part of that.
Coordinated care is reminiscent of a Health Maintenance Organization (HMO); however, the difference between the two is that an ACO does not have a gatekeeper like HMOs thus patients are free to see whichever provider or specialist accepts his or her insurance. Another key difference between ACOs and traditional hospital and physician payment programs is how they are paid. As mentioned above, healthcare systems are rewarded for coordinated quality care that is not duplicated; essentially, the program rewards health systems for keeping patients out of the hospital. In an ACO, hospitals are fined for readmissions and rewarded for reducing costs and population health. Although that sounds great from a patient’s perspective, it is a huge culture and financial change in the business of healthcare. In a descriptive study performed by Epstein et al., they found, “…no differences in baseline quality between hospitals that participated in an ACO and those that did not…found only modest differences in baseline
According to Rittenhouse in 2011, An ACO is a provider-led organization whose mission is to manage the full continuum of care and be accountable for the overall costs and quality of care for a defined population. Joining in Accountable Care
You might think that the United States has the best healthcare system when compared to the other countries, on how much it is spending on the cost of health care, which is more than 17 percent of its economy, but underperforms when it comes to measurable outcomes. Quality of care that the US healthcare is deficient is on patient safety, health prevention, coordination of care, positive patient outcomes and access to care (Obama, 2016). The practice change that I will cover in my paper is the nursing’s role in Accountable Care Organization (ACO), and how it relates to the health care reform and in supporting the Institute of Medicine’s (IOM) initiative titled “The Future of Nursing: Leading Change, Advancing Health.”
From the end of 2012 to the end of 2013, the number of public and private sector ACOs increased by 203 percent. During that same period, ACO covered lives increased from 13.6 million to 18.2 million, a jump of 34 percent. A report from the