Challenges Of Accountable Care Organizations

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

Coordinating Primary Care/Team Effort: “patient Centered Medical Home” Geisinger calls it “Personal Health Navigator” aims to help patients manage all the complexities of their care in one setting. Focus on putting patients/families at the center of care. Doctors, nurses, technicians and case managers (who coordinates it all). Constantly

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,

Patient-centered care refers to the view that patients and their family members are partners in developing a care plan. This stems from the belief that the patient is in control and that the care provided is rooted in respect that addresses the patient’s personal needs and values (Barnsteiner & Sherwood, 2012). Creating a partnership with a patient that allows them to grasp the goals and methods of their plan of care and includes them in the decision-making process can prevent errors from occurring. This gives the patient the opportunity to correct any

Berry, L., Rock, B., Houskamp, B., Brueggeman, J., & Tucker, L., (2013). Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clinic Proceedings, 88(2), 184-94. Retrieved from http://search.proquest.com/docview/1312503895?accountid=34574

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

Some of the likely direct benefit of better coordinated care would be; reduction in the need for acute care services such as hospitalizations and over utilization of emergency room. Developing coordinated medical homes to prevent, diagnose and treat disease early will save health care cost. Also, CMS estimates shows that, 45 percent of hospitalizations of dual eligibles from either Medicare skilled nursing facilities or Medicaid nursing facilities in 2005 could have been avoided if health care are well

The Medicare-Medicaid Coordination Office serves people who are enrolled in both Medicare and Medicaid. The goal is to make sure whoever has enrolled in the Medicare-Medicaid program, will have full access to seamless, high quality health care, and to make the system as cost-effective as possible. The Medicare-Medicaid Coordination Office works with the programs across Federal agencies, States, and stakeholders to align and coordinate benefits between the two programs effectively and efficiently. We partner with States to develop new care models and improve the way Medicare-Medicaid enrollees receive health care. The Medicare-Medicaid Coordination Office was established in Section 2602 of the Affordable Care Act and the goals of the Office

Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care

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

Care coordination within health care systems ensures the client of an effective and short stay. Care coordination refers to the coordination between and among professional teams that serve valuable roles involved in providing care to clients. Different disciplines of health care professionals include nursing, medicine, case management, pharmacy, nutrition, social work, and allied health professionals, such as speech therapists and physical therapists. They are found in all health care delivery systems and are extremely effective when the focus is strictly on the needs of the client. Interprofessional teams are valuable because each health care professional has specialized knowledge and skills so that health care plans are determined with

Using a new pattern that effectively addresses and plans the needs of the person with disabilities and/or chronic illness and effects of multiple health-related conditions on their lives is needed at this time in health care. Care coordination, rather than case management, for individuals with multiple and chronic conditions is being supported by many proponents and incorporated into physician offices, insurance providers, and both short and long term care facilities. The responsibility of the care coordinator is fundamentally important to ensure effective communication and information exchange within and between organizations, including health care providers, social service providers, and state and county government agencies, resulting in high quality care and support for the individual with complex health care and other needs.

An example of a population that would benefit from care coordination is the aging, elderly and frail elderly. As most people age, they want to remain as active and independent as possible for as long as possible, maintain an excellent quality of life, and live at home surrounded by family and friends—not in institutions like nursing homes (Rantz, et

Successful collaboration for community health centers is increasingly important to the day-to-day functionality of the setting. Furthermore, Community Health Centers are considered the heartbeat of care for the uninsured making collaborative process fundamental in its ability to carry out its objectives. Collaboration encourages cohesiveness. The need to work hand in hand is fundamental (Huang & Perroud 2003).