The Affordable Care Act : A Catalyst For Payment And Delivery System Reform

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The fragmented and misaligned state of the U.S. health care system has become a catalyst for payment and delivery system reforms. Traditional fee-for service (FFS) payment structures incentivize high volume rather than high quality care, and lead to the suboptimal provision of medical services across the disjointed provider landscape. Despite various attempts to improve care delivery, health care costs continue to rise. The Accountable Care Organization (ACO) model seeks to reverse these trends by promoting a simultaneous restructure of the payment and delivery systems to incentivize higher quality, lower cost care. In todays’ healthcare most people with private insurance today get coverage through their employers. Public programs provide…show more content…
ACOs can be classified into six categories based on the number and leadership structure of parties involved in the ACO, the services provided directly by the ACO, and the services provided through contracted entities (see Table 1). ACOs can range from an “Independent Physician Group” that only directly provides outpatient care, to a larger, “Full-Spectrum Integrated” ACO that directly provides all core medical services, from ambulatory to inpatient and to post-acute settings. Using this taxonomy to identify different ACO types can help providers learn from like-entities by distinguishing structural commonalities between different organizations, and by highlighting common approaches to managing patient care. Further research using this taxonomy can also help ACOs and researchers’ alike better understand performance to date of these different accountable care arrangements and the factors most critical for success. If they hit the quality targets, any savings that result are then shared among the providers, on that same token if they miss targets they can end up owing money back to Medicare. ACOs get paid based on their patients’ medical outcomes rather than on how many tests and procedures they perform. Under the Pioneer model ACOs are paid at fee-for-service rates, but then can earn payments or have to pay-back money based on patient outcomes. A major
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