The Affordable Care Organizations

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,

ACO, another 3 letter health care organization consisting of integrated groups of providers, comes along promising the elusive goal of reducing health care cost, improving population health, and bolstering custom satisfaction. Sounds like a perpetual remake of a 70s movie called HMO that went through several reiterations over the past decades which gave us PPO, PSO, IDS, and the different flavors of MCOs. ACO’s hype is credited to the Affordable Care Act as it sought to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Bottom line, providers are promised to make more if they

The concept of an Affordable accountable cCare oOrganization (ACO) is still evolving. Generally, an ACO is a group of health care providers (including primary care physicians, specialists, and medical facilities) that work in partnership and are collectively accountable for the cost and quality of health care they deliver to a specific population of patients. At the heart of each patient's care is a primary care physician.

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,

What is the Accountable Care Organization? “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html). The ACO is a component of the Affordable Care Act (ACA). “The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA, and generally referred to as Obamacare – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010” (www.healthinsurance.org). One of the main reasons the ACO mainly focuses on Medicare patients because due to the aging, their health problems will become chronic disease and that will have an impact on the healthcare cost years to come. It is stated that about 78% of the total health care is spent for chronic diseases.

The third type of ACO, the Advanced Payment ACO Model, provides additional support to physician-owned and rural providers who would benefit from additional start-up resources to build the necessary infrastructure. Selected participants in this model would receive upfront and monthly payments. The Advanced Payment ACO Model provides additional support to physician-owned and rural providers who would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems.

As the continued support grows the PCPCC, the health care sector is recognizing the role of the medical home model, Accountable Care Organizations(ACO), many entities are embracing the model and performing better. According to Center of Medicare and Medicaid, the medical home model shows that there is an improvement cost effectiveness, which helps practitioners deliver quality care and advanced approaches to care coordination, care teams, and chronic disease management. As evaluations of ACOs, integrated health systems, and the medical neighborhood continue, the Patient Center Medical Home will be essential to driving improvements in cost, quality, and outcomes. [3]

Coordinated care is reminiscent of a Health Maintenance Organization (HMO); however, the difference between the two is that an ACO does not have a gatekeeper like HMOs thus patients are free to see whichever provider or specialist accepts his or her insurance. Another key difference between ACOs and traditional hospital and physician payment programs is how they are paid. As mentioned above, healthcare systems are rewarded for coordinated quality care that is not duplicated; essentially, the program rewards health systems for keeping patients out of the hospital. In an ACO, hospitals are fined for readmissions and rewarded for reducing costs and population health. Although that sounds great from a patient’s perspective, it is a huge culture and financial change in the business of healthcare. In a descriptive study performed by Epstein et al., they found, “…no differences in baseline quality between hospitals that participated in an ACO and those that did not…found only modest differences in baseline

An Accountable Care Organization (ACO) is one example of these inter-professional models of care delivery. ACOs are structured so physicians, nurses and other health providers can collaborate and work together in the delivery of quality while also being cost-effective. ACOs may also involve home care institutions, medical homes and even hospitals (Hart, 2012). In addition to being cost-effective, an ACO may be eligible to receive incentives if they meet performance and quality standards (Haney, 2010). Their emphasis is on primary care, wellness and health prevention. Given the focus of such entities, ACOs have the potential to reduce health care costs by eliminating redundant care, preventing unneeded hospitalizations and needless trips to urgent or emergency care services by providing coordinated care. Lessening trips to urgent care facilities and eliminating hospital admissions arguably, is already a positive patient outcome. Advance Practice Nurses (APNs) such as, Nurse Practitioners have the opportunity to lead an ACO entity, especially in remote communities (Haney, 2010). Having APNs available, sick individuals can seek immediate assessment and primary treatment prior to seeing specialists. Managing symptoms early may prevent complications down the

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

Within the MSSP there are two “tracks” for ACOs to choose between depending on the amount of risk the ACOs wish to undertake. These two tracks increase the likelihood that more ACOs will choose to affiliate with Medicare by offering a range of financial risk that can be incurred by the ACOs. Track 1 permit ACOs to obtain 50% of the savings if said ACOs are under the budget that has been established by Centers for Medicare & Medicaid Services (CMS). Additionally, these Track 1 ACOs are not monetarily penalized if their organization goes over the CMS budget. The second track is referred to as the Pioneer ACO model that is geared towards providers who are willing to accept more financial risk in the form of monetary penalties if their ACO goes over the budget provided by CMS. In return for accepting this risk, those Pioneer ACOs are able to acquire 60% of the shared savings .

According to Rittenhouse in 2011, An ACO is a provider-led organization whose mission is to manage the full continuum of care and be accountable for the overall costs and quality of care for a defined population. Joining in Accountable Care

You might think that the United States has the best healthcare system when compared to the other countries, on how much it is spending on the cost of health care, which is more than 17 percent of its economy, but underperforms when it comes to measurable outcomes. Quality of care that the US healthcare is deficient is on patient safety, health prevention, coordination of care, positive patient outcomes and access to care (Obama, 2016). The practice change that I will cover in my paper is the nursing’s role in Accountable Care Organization (ACO), and how it relates to the health care reform and in supporting the Institute of Medicine’s (IOM) initiative titled “The Future of Nursing: Leading Change, Advancing Health.”

From the end of 2012 to the end of 2013, the number of public and private sector ACOs increased by 203 percent. During that same period, ACO covered lives increased from 13.6 million to 18.2 million, a jump of 34 percent. A report from the