Accountable Care Organizations
The health reform law of 2010 aims to improve the health of the population and the quality of health care delivery while reducing costs. In addition to expanding coverage to 32 million previously uninsured Americans. One tool to pursue these goals is the creation of a national voluntary program for accountable care organizations.(ACOs) (allhealth.org). Healthcare today is fragmented; ACOs would bring it all together the different components parts of care for the patient such as primary care specialist, hospitals, home health care, etc. and make sure that all the parts work together. Accountable Care Organizations (ACOs) are networks of physicians and other providers that could work together to improve the quality of health care services and reduce costs for a defined patient population. It is estimated that Medicare will save $940 million in the first four years alone. Today most public programs and private insurance plans pay for health care on a fee for service basis. This means that doctors, hospitals, and other providers are paid for each service they furnish to a patient. Critics of this system contend that it creates incentives for providers to furnish or order more services. Different providers who see the same patient often fail to coordinate their activities, leading to duplicate or conflicting treatments. (Healthaffairs.org)
The ACO focuses on clinical integration of a network of providers, with incentives for providing care with a focus on quality while reducing overall utilization. In order for the ACO to be successful a number of core competencies must be addressed. These include: * Developing Physician Leadership
* Changing Participating Physician Behavior
* Development of Processes for Integrating the Continuum of Care * Implementing Information technology Systems to report and measure on Quality and Cost * Developing a Compensation model to Give Physicians Incentive to Participate * Marketing the Concept to Payers and Patients to Build Volume and Drive Support According to The Camden Group (Riegel, B and Tung, C ) ACOs have been defined as organizations that : A. Can provide primary care and basic medical/surgical impatient care for a population of patients B. Are willing to take responsibility for the overall costs and quality of care for the population. C. Have the size and scope to fulfill this responsibility. ACOs will probably include one or more hospitals and could include nursing homes, outpatient centers, home healthcare, rehabilitation and other providers of medical care to seniors and others enrolled in Medicare. ACOs will make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary test and procedures. Those that save money while also meeting quality targets would keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward. The ACO concept began with the observation that physicians who are tied to a particular hospital often already function as a sort of informal network for most of their care. These facts suggest that groups consisting of one or more hospitals and doctors who use the hospitals, but aren’t employed by the hospital might be brought together in organized systems. Public and private payers could then hold these systems accountable by assessing whether they provided high-quality care to their usual patient population while reducing the unnecessary use of resources. Organizations that took steps to improve their performance would be financially rewarded; this would encourage further steps to improve care management, leading to further rewards and a steady evolution towards fully coordinated care systems. This writer found through researching this topic that there are many obstacles that will need...
Please join StudyMode to read the full document