Accountable Care Organization Analysis

Currently, the Affordable Care Act establishes nurse practitioners as providers whom are eligible providers in ACOs; however, the current Medicare Shared Savings program statute prevents beneficiaries of Medicare, who are receiving primary care service from a nurse practitioner, from being assigned to Accountable Care Organizations inside the program (AANP, 2015). The American Association of Nurse Practitioners (2015) also claim the exclusion of nurse practitioners must be repealed if ACOs want to develop further as models of practice, which improve cost effectiveness, patient access and quality.

The Affordable Care Act created a new approach to care which is called the Accountable Care Organization. ACO is a system of doctors and hospitals that share a financial and medical responsibilities. If the ACO is successful in meeting quality and cost savings targets, these organizations qualify for financial incentives or shared saving from Medicare programs. The goal of the ACO is to coordinate

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 Affordable Care Act has created many opportunities for states to design and test new models of care delivery and payment that improve health outcomes, improve patients’ experience, and reduce health care spending ("The Promise of Care Coordination: Transforming Health Care Delivery", 2013). These new models include accountable care organizations (ACOs) and Medicaid health homes. A main component of these new models is care coordination programs, which allow providers and other members of the health care system to work together for the benefit of the patient ("The Promise of Care Coordination: Transforming Health Care Delivery", 2013).

This vision has led many to take healthcare to a new levels in America. The Accountable Care Organization ACO shareholders provide a model of healthcare where value becomes more noticeable, not focusing on personal gain everyone is focusing on the patient health with a common goal. Collaboration and open communication to reach optimum ways to treat each public in a holistic way. With this new approach patient can be sure that all their health related problems will be met because everyone in the team is on the same page. Nurses can be instrumental in that category advocating on behalf of

In reviewing the article you referenced, “Affordable Care Act Initiative Builds on Success of ACO’s”, one could recognize that the Centers for Medicare & Medicare Services (CMS) has identified issues with their original plan for Accountable Care Organizations (ACO). As you have stated, they have decided introduce a newer version called “The Next Generation ACO Model” (HHS, 2015). This “next-gen” model aims to “create greater coordination and close care relationships between ACO providers and beneficiaries” (HHS, 2015).

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.

The Accountable Care Organization would vastly reduce occurrence of repeat testing. This procedure reduction would create efficacy of health professional’s time and reduce unnecessary spending. In addition to the cost effectiveness of the Affordable Care Act the Accountable Care Organization creates alternatives to reducing local spending by creating an integrated network.

There are three core principles to any ACOs. First, provider-led organizations with primary maintenance and a strong base are liable communally and total per capita costs for quality with full continuum for the population of care for patients. Second, excellent improvements will have linked to also have complete costs reduced, and third, progressively and reliable sophisticated measurement performance to improve, support, and provide the savings of confidence are achieved with improvements of care, , McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES (2010).

The Accountable Care Act put in motion a change from a volume based system to a value based system. With this change, primary-care organizations become the frontline healthcare providers. These organizations drive both individual and continuity of care for their patients. Because chronic conditions account for a large portion of overall healthcare expenditures, having high-performing primary care organizations is quite important. According to Willard and Bodenheimer (2012) there are six building blocks for high-performing primary care organizations:

The medicare ACO strategy is based on the concept of reducing the medicare expenditure by moving from a provider fee for service model to a cost controlled model based on a defined network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients at a reduced or fixed price.

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

(ACO).” The ACO contracts with payers to be accountable for the entire continuum of care provided to a defined population, and if the costs of care provided are less than targeted amounts, and certain quality measures are achieved, the ACO and the payer are rewarded with a portion of the savings. Under the Medicare Shared Saving Program, the Centers for Medicare & Medicaid Services (CMS) will contract for ACOs to assume responsibility for improving quality of care provided, coordinating access across providers, and reducing the cost of care that Medicare beneficiaries

Preventing the duplication of medical services by itself is an asset to the health care system. I use to work in the emergency room(ER) of a level one trauma hospital in Portland, Maine. It was common for very sick but stable patients from other ER to be transferred to our ER for a higher level of care. Frequently medical tests would be re-ordered(duplicated) because waiting for the patient's official medical records from the former ER takes a fair amount of time. Waiting for the reports, was typically considered a waste of time because it was delaying the care of the patient. These duplicated tests were an inconvenience to the patients and were an unneeded expense for the healthcare system. Once ACOs are established and successful, I hope

ACO is an organization that focuses on coordinated care through a group of physicians and hospitals for a defined population that directly interacts with the payers instead of going through health insurance plans (Beasley, 2015). The primary goal of ACO is to provide higher quality care while reducing the healthcare costs (Beasley, 2015). To According to Macfarlane (2014), a number of Centers for Medicare and Medicaid Services (CMS) have been promoting ACOs, due to which over the past few years the number of ACOs have expanded to more than 300 organizations. To further promote the use of ACO, CMS has even implemented a shared saving program as a promotional scheme (Beasley, 2015).