Affordable Care Organization Case Study

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,

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

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).

Advance Payment Account Care Organization Model which focuses additional support to physician owned and rural providers participating in the Medicare Shared Savings Program by providing start-up resources to build better infrastructures throughout. The shared savings which the Accountable Care Organization (ACO) would be split in half and given back to the organization which provided the savings. In other words, in the case of my hometown hospital, if an ACO would take over and re-open our hospital, the predictions are that by retrieving these savings which are provided for by Obama-care, and by right-sizing our hospital from a 45 bed hospital to a 10 bed hospital and right-sizing the amount of employees, we would be back in the black within a 2 year period. That is a major step in financing this hospital to continue servicing a major part of the community which needs major health care to continue.

The Accountable Care Collaborative is Health First Colorado’s program that is the primary resource to provide enhanced coordinated care. The three primary goals of the ACC program are to better health, improve the experience of both the providers and the ACC members, and to contain costs. The ACC connects primary care medical providers (PCMPs), the statewide data and analytics contractor (SDAC) and the Regional Care Collaborative Organizations

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).

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 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

During our previous strategic planning committee meeting, interest was sparked regarding our organization becoming part of an Accountable Care Organization (ACO). At that time, it was unclear how this change would impact the organization’s financial performance. After some research, and review of our current financial profile, their clearly exists an opportunity to significantly improve, across the board, our organization’s financial position. Please review the following analysis as part of your consideration for our organization joining an ACO.

Based on an article written in the Journal of Health Policy, Politics and Law to increase the value and quality of health care services provided to Medicare patients there is a need for health care professionals to focus more on working as a team to coordinate care. The purpose of establishing an ACO is to achieve high quality outcomes in the most effective manner. By establishing an effective ACO would provide benefits to patients and health care professionals within the community. By accepting the government’s offer will allow patient care to improve, decrease health care expenses and will overall benefit the health care providers within the organization.

Accountable Care Organizations (ACOs) are group of physicians, hospitals and other healthcare providers coming together voluntarily to deliver high quality healthcare to patients. On the other hand, American Hospital Association (2010) defines ACO as legally structured arrangements between hospitals, specialty physicians and/or primary care and other healthcare providers to facilitate effective and efficient healthcare for a defined patient population. Typically, ACO focuses on assisting patients with chronic disease to get right care at the right time with overall goals of preventing medical errors and unnecessary duplication of healthcare services. More importantly, ACO focuses on delivering high quality healthcare at low costs. The Health and Human Service (HHS) estimates that ACO could assist Medicare to save more than $960 Million in the first three years, which will assist Medicare to spend healthcare dollars more wisely. (Centers for Medicare & Medicaid Services.2012).

The Accountable Care Organization and Patient Centered Medical Home case studies both did best to implement pilot programs, models and experiments that will essentially coordinate at the same time integrate healthcare goals with the healthcare system aimed at improving patient outcome and lowering costs for quality service. PCMH also did best in making sure patients had constant access to their providers at the same time provide care that was team based by coordinating care with various providers at the same time assure the quality and safety of each patient. As for ACO they did best in their improvement of care and lowering cost by coordinating with physicians and institution that are providing care to Medicare beneficiaries. Their ultimate goal is improving the quality and value of health care services at the same time control costs while improving the delivery of healthcare by measuring quality and satisfaction as defined in Shi and Singh (2015) Donabedian Model which can be achieved by establishing structure, process and outcome (p. 494). In the end ACO and PCMH focused their attention in preserving wellness, disease prevention, and treating illness by assuring that each patient received the best care possible from their health care providers.

Large hospitals have chosen to become ACO providers. Accountable Care Organization (ACO) which are of doctors, hospitals and other healthcare providers, which come together voluntarily to give coordinated high quality care to the Medicare patients they serve.

The ACOs major goal is making practitioners take responsibility of patient health care outcomes and reduce spending (Matthew et al., 2011). Furthermore, the participants that make a decision to join the ACO will be given incentives to help improve the quality of healthcare, and decrease unnecessary test and treatments (Matthew et al., 2011), in other words, it will regulate spending.

DeVore and Champion (2011) defined Accountable Care Organizations (ACO) as groups of providers who take responsibility for improving the overall health status and care efficiency for a defined population.