Affordable Care Delivery: A Case Study

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.

​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 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).

Accountable care organizations are growing. Accountable Care or Coordinated Care is putting consumers at the front at our evolving healthcare industry. Accountable Care Organizations (ACO) strive to improve outcomes and reduce costs with improved patient care coordination (Robinson, J. C., Schaffer, L. D. 2015). Coordinated Care is defined as the Right care, at the right time, with no duplication, and to prevent errors. The Affordable Care Act encourages health care organizations to improve quality of care and reduce spending. In 2013, there were 320 ACO’s and as of 2014 there are now 700. 2/3 of the population now live in an area that services ACO’s. One out of three hospitals have ACO plans (Perficient Inc. 2015).

The U.S. healthcare system has considerably transitioned from a period of traditional care to managed care to accountable care. The success of the accountable care regime would largely depend on the ability of ACOs to deliver on promises of cost reduction and quality improvement. And if it does, to sustain the feat. Given annual changes and additions to its forms and measures, ACOs are still in formation and at this stage, it may be untimely to tell if they are indeed the unobtanium of healthcare. Its aim of managing the basic elements of care – cost and quality all in one piece definitely comes with challenges which have been discussed. Nevertheless, it would take time for the health system to completely adjust to the period of accountable

The Affordable Care Act (ACA) is a complex federal law that affects health system of the United States in every aspect. ACA goals is to improve quality of healthcare; increase access, and to stabilize and possibly reduce the cost of the healthcare services. ACA provisions include, but not limited to, expansion of Medicaid to all individuals less than 65 years of age whose income is 133% of the Federal Poverty Line (FPL) or below; created Consumer Operated and Oriented Plan a nonprofit, member-run health insurance companies in all 50 states; prohibits existing health insurers to deny coverage due to preexisting conditions; allows states to create a Basic Health Plan for individuals without health insurance and income range of 133-200% FPL; improves prevention services by requiring health plans to include basic preventive coverage without cost-sharing; improve access to health care by providing additional funds for community based health centers and other community based organizations(Knickman, Kover, 2015. Pp344-361). Every provision of ACA will bring significant change to every area of the healthcare and, as a result, changes in access, quality, and cost. These 3 components of the healthcare system are intertwined and change in one will cause the change in the others.

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

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,

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).

Providing enhanced access to a better quality health care system is reliant upon the identification and modification of various barriers, which must be addressed. Complex health care systems and politics generate barriers to the delivery of high-quality access to care through knowledge deficits. Consumers are tasked with understanding what services are needed as well as their abilities comprehend their diagnoses are challenged. They must also over come barriers to communication to converse effectively with caregivers. Most importantly, they must understand their role in the process as patients and citizens when accessing health care services. (Ricketts, 2013) Comprehensive provisions built into the ACA help to energize endeavors aimed towards developing ways to ensured enhancements to the quality and access to health care provided in North Carolina. Accountable care organizations (ACO) were

The 2010 Act on Affordable Care was projected to effect expansion of the insurance coverage on health to about 34 million people. It was aimed at reforming health insurance coverages, improving the efficiency, quality and efficiency of primary health care, ensuring the easy access of health care by the medically underserved population as well as improving the training of health professionals and public health. It has resulted in various positive impacts to the community. First, it has expanded the insurance coverage which means that some clinical service cases may be transferred to the private sector. Secondly, it has introduced new models of care delivery which have created opportunities for integrating the public health principles and enhancing

The Patient Protection and Affordable Care Act (ACA) was signed into law in 2010. The ACA is considered the most expansive healthcare reform legislation in the United States since the formation of Medicaid and Medicare in 1965 (Berg & Dickow, 2014). The creation of the ACA ushered in a new progression for the United States healthcare system that put an emphasis on preventive services and primary care (Berg & Dickow, 2014). The ACA also aided in the public problem of the being uninsured in this country. It worked to provide insurance coverage to millions within the United States who are currently uninsured. The ACA is also working to combat the problem areas within the current healthcare system that are of need of modification so that the consumer needs for safe care and improved health outcomes are met (Berg & Dickow, 2014). The Patient Protection and Affordable Care Act’s goals are to the address many different components of reform. It addresses implementing ways for quality, affordable health care for all Americans, the role of pubic programs, enhancing the quality and efficiency of health care, the prevention of chronic disease as well as improving public health, the health care workforce, improved transparency and program integrity policies, improve the access to innovative medical therapies, community living assistance services and supports, and lastly, revenue provisions (Berg & Dickow, 2014).

Health care spending grew 3.7 percent in 2012 and the traditional way medicine was practiced had to change (Edlin, Goldman & Leive, 2014). The Affordable Care Act and Population Health was designed based on the concept of “The Triple Aim” to foster change in patient care by providing better care for individuals, better health for populations and decrease the cost of health through improved care (Perez, 2014). As a result, population management has moved to the front by linking services, reducing hospital admission, risk stratification, pursing preventive medicine, ensuring medication review and lowering health care cost. Several organizations have follow in the pursuit of population management by forming Accountable Care Organizations

On March 23rd, and March 30th, 2010, President Barack Obama signed the paperwork for the Patient Protection and Affordable Care Act (ACA). This act is a law that was put into place to help make sure all Americans could have access to affordable, quality health insurance coverage. The ACA has now been available for five years with more than sixteen million people insured through it. “Over a period of several years of implementation that began in 2010 and will continue through 2019, the spectrum of the ACA provisions will change how health care is delivered and financed in ways that vastly exceed the impacts of Medicare and Medicaid.” (Sultz & Young, 2014, p.xxiv) The ACA is a law and in this paper, I will be discussing the major components of it which are Titles I-X and how it has improved the health care delivery system in the United States. This act is extremely important to Americans because it helps to make insurance affordable and keeps premiums down.

When Obama was sworn into presidency he implemented many new healthcare initiatives in order to reform the quality of care and strive forward towards having healthcare be available to everyone. The Patient Protection and Affordable Care Act was a significant effort to expand healthcare to all citizens, but the part of the act that is not as well known is the proposal of Accountable Care Organizations (ACOs). Accountable Care Organizations are an initiative for providing better, more universal healthcare throughout all stages of life, especially focusing on the care of Medicare beneficiaries. An Accountable Care Organization is a network of doctors, nurses, hospitals, and health care providers that all agree to give coordinated care to Medicare patients by having responsibility of the cost and quality of patient care. The goal of these organizations is to have a group of people that all know the patient’s history and, therefore, through transitions the patient is able to receive quicker and higher quality of care for less cost of both the patient and provider. The effectiveness of Accountable Care Organizations depends upon the cost-effectiveness, professionals voluntarily giving care, and, most importantly, the way in which it affects patient care.