Advantages Of The Integrated Physician Model

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

Clinical integration is the overall purpose of an integrated physician model. Clinical integration provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs (Harrison, 2016). This needs to be a major factor in the planning process. When you have the capability and access to an patients care plan because of greater resources and having all of the necessary silos to provide such care, well then it becomes a much smoother process and as a result this can play a factor into timely care and quality of care, as well it can contribute to cost reducing factors such as outpatient care. The electronic health records allow each silo to have access to treatments and testing that has already been done, this further improves quality, timely, and costly care. The clinical pathways allow creating a standardized care plan for patients that over time become more effective and efficient. The management of chronic diseases before clinical integration could be very costly and painful, requiring the patient to see multiple facilities and doctors with limited communication between the different facilities. With success in clinical integration these patients can have easy access to their providers and information because it would all be tied together, it can reduce the stress of knowing everything themselves because the information would already be

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

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

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

This paper will discuss what the Accountable Care Organization is, why did Congress include it in their law, benefits and challenges for physicians and patients, and how does the ACO work for patients. We will also identify the quantitative methods in the ACO and reflect on the information provided.

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.

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.

Accountable care organizations (ACOs) are consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth.

The health restructuring dispute has centered on compensating providers particularly more when delivering quality care to their patients than for enhancing the volume of services they provide (Ries, 2014) Accountable care organizations (ACOs) is a single proposed way of altering compensation methods to accomplish this objective by generating encouragement to enhance care coordination and clinical integration (Thygeson, Frosch, and Carman, 2014).

​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).

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,

Given huge potentials and resources, the healthcare system in the United States stands among the best in the world; however, it has been constantly plagued with issues of cost, access, quality and distribution.1 The national health expenditure levels on per capita basis as well as the percentage of GDP has for several years remained higher than other OECD countries but has in contrast, been ranked low on significant health indicators.1,2 As part of the ongoing healthcare reform efforts, the Affordable Care Act (ACA) was passed in 2010 which led to outright and possible immense changes in healthcare.1 Accountable Care organizations (ACOs) were presented as the healthcare delivery system signature of the ACA, as a novel Medicare payment model.3

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

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