Duplicated Health Care Case Study

The landscape of payment and organization in health care is changing again. As the federal government, states, and individual payers continue to migrate towards the ACOs, physicians and hospitals will face increasing pressures to change and adapt to new incentives surrounding cost and quality. As a hospital administrator, being able to adapt is a key to survival in an ever changing health care environment. I would definitely support explorative evaluation of our capacity to form an ACO and piloting a voluntary contract with Medicare and/or Medicaid.

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).

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

ACOs provide high-quality care to their patients and reduce cost by avoiding unnecessary duplication of services and preventing medical errors. ACOs may involve a variety of provider configurations, it can range from integrated delivery systems and primary care medical groups to hospital-based systems and virtual networks of physicians such as independent practice associations (McClellan et al, 2010).

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

​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).

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 first ACO model started January 1, 2012 and consisted of 32 ACOs with 860,000 beneficiaries (CMS, 2016). ACOs are made up of groups of hospital, doctors, and other health care providers who provide coordinated high quality care to their patients. The goal of this coordinated care is to ensure patients receive the appropriate care in a timely manner while avoiding unnecessary services and duplication of services. The expected end result is the delivery of high quality care and reduction of health care cost and the incentive for the health care provider to meet the goal is the share of the savings they will receive. As stated by Dr. Berwick, (Its (ACOs) purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care” (Berwick, 2011). The ACO providers are held responsible for meeting quality improvement measures while reducing their rate of spending.

Accountable Care Organizations (ACOs) came into being in 2010 after the passage of the Affordable Care Act (ACA) also known as Obamacare (Mayberry 2016). ACOs today in the United States number about seven hundred, with over twenty million customers (Scheffler, 2015, p. 640). The twenty million customers, consists of customers covered by Medicare and private insurance contracts (Muhlestein, 2015, as cited in Scheffler, 2015). ACOs were created to improve healthcare, by delivering efficient healthcare services at lower cost. “The goal of ACOs, which consists of physicians, and hospitals, is to improve the quality of health, health outcomes, and health care spending among its attributed groups” (Mayberry, 2017, p. S61). Each ACO is required

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).

On June 28, 2012, the United States Supreme Court issued a decision that made the enforcement mechanism for the ACA Medicaid expansion optional for states. Regardless of that decision, the Affordable Care Act (ACA) has reduced the uninsured rate since its complete implementation in 2014. The original intent and projections were that all states were expected to expand Medicaid. However, after that Supreme Court decision, some states chose not to expand Medicaid.

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

Additional advantages to being a part of an ACO include promoting health information exchange, improving the accuracy of diagnosis due to the involvement of a treatment team approach, and the ability to handle more complex cases. Additionally, ACO’s allow for an increase in the treatment options for patients, which improves patient outcomes and patient satisfaction, which in turn supports the growth our patient

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.