Question

Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare and Medicaid Services to help facilitate this cooperation.

Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).

Write a 700- to 1,050-word executive summary that discusses the purpose of joining an ACO and the funding available through one. Include the following:

Evaluate industry dynamics that would influence your organization's decision to participate in an ACO.

Identify the steps needed to participate in an ACO.

Justify participation in an ACO for your organization.

Answer 1

ACOs or Accountable Care Organizations are groups of doctors, hospitals and health care providers who work voluntarily and give high quality coordinated medical care to the patients.

The purpose of this highly coordinated care is to ensure that patients and in particular the patients who are chronically ill get the right care at right time without any medical errors and duplication of services.

The health care system is undergoing a considerable change to focus on the quality and cost health care. ACOs contribute generously to these efforts by rearranging current payment system and incentivizing organizations for attaining high-quality medical care

Medical doctors are leading providers of such care and are gaining foothold in becoming largest drivers of accountable health care. Usually, ACO are not affiliated to any hospital, it includes more than one primary care physician groups or practice groups who have large patient base. Many such ACOs limit themselves to provide only primary care but still take up the responsibility of maintaining total cost of patient care. Their efforts are laudable as they have been able to deliver high quality care which has effectively improved patient result, bringing down hospital and emergency room visits and admissions which in turn have lowered the costs

Successful health management for people in these ACOs has resulted in providing more care services at a lower care cost and less medical services at higher cost in hospitals. Due to the smaller size of these physician led ACOs, they are quick to adapt top any changes or adopting of new medical practices and transformations.

Conversely, these ACOs might have less advanced systems, lesser resources and money to invest in clinical transformation. Few results from Medicare Shared Savings Program (MSSP) have shown that these ACOs have actually proved to be successful in accountable medical care. These positive findings suggest that the physician led ACOs have started playing an important part in health care reforms. The reason for this study is to concentrate on rare and exceptional challenges and opportunities faced by these ACOs

ACOs operate on a multiple range of payment models, e.g., service fees which might be with or without sharing it with benefit arrangements).

The conventional payment model does not give the incentives to support ACOs. It is expected that the ACOs will see rise in the reimbursements under capitated model. Under this model, the ACOs get incentives; have best possible quality, security, competence and health results.

ACOs are answerable to their patients and 3^rd party payers for quality, suitability, competitive and safety of the healthcare provided through them. While attending to ill and injured, health care providers also focus on the preventive healthcare. This gives them greater financial rewards than in treatment of the ill. They are also deterred from using costly and newly developed treatments as they may have less, marginal or no success for patient treatment.

Physician led ACOs usually lack prerequisites of accounting, actuarial, underwritings, finances and managing risks. But, the most important issue is the greater variation while estimating average annual patient costs.

ACOs can likely be sponsored by various existing healthcare companies including bigger ACOs and other hospital alliances. Bigger companies and conglomerates have greater organizational skills which are imperative for an ACO. But, individually, these organizations fall short of complete expert package including the experts and infrastructure required to manage large population and risks.

Few steps which can be taken to participate in ACO are:-

1.        Understanding of an ACO model

2.        Recognizing the use of Information and technology

3.        Employing clinical strategies

4.        Assuring healthcare to lower cost in-network hospitals

5.        Following quality assurance matrices

6.        Improving health care for all the patients

ACO participation for any organization is a big step as they would be responsible for human lives and giving the quality medical treatment to all the patients. My organization has the expertise in dealing with all the risks and challenges due to the fact that we have been in business since a long time and have been taking up all these risks and challenges for our other businesses also. We are committed towards achieving our goals and providing quality and better health services for all the people who would like to have quality health care but are not financially fit to do so.