The Importance Of Accountable Care Organizations

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).

Accountable care organizations (ACOs) are consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth.

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

​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).

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.

This is a performance-oriented organization devoted to improving the level of health care given to children. After its establishment in 1999, principal focus was to get rid of the gap the links what is and what can exist in healthcare for every child. Its main emphasis was to put a stop to childhood obesity, promote centered care for children with chronic conditions, and to promote equity in care for everyone. Under the management of experienced professionals in children healthcare, its work focused towards improving children's healthcare to realize this goal through awareness. NICHQ drives attention towards the need to spread the message of success demonstrating the possibility of improving children's health care to realize better outcomes. It conducted a project to fit in excellence upgrading and cultural proficiency in clinics.

The ACA establishes the Shared Savings Program in a new section 1899 of the Social Security Act. ACA § 3022 (codified at 42 U.S.C. § 1395jjj). The purpose of the program is to bend the health sector cost curve, and to facilitate coordination and cooperation between providers to improve quality for fee-for-service Medicare beneficiaries. Eligible providers can (but are not mandated) to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (“ACO”).

Organization such as “Accountable Care Organizations”4 is one of the ways to ensure the quality of care for Medicare patients. The organizations combination of doctor, hospitals, and other health care providers who came together to ensure the quality of care for Medicare patients. This will help with effective communication with patients and clinicians, and help avoid medical

According to Shi and Singh an accountable care organization, also known as an ACO, describes an integrated group of providers who are willing and able to take responsibility for improving the overall health status, care efficiency, and satisfaction with care for a defined population. The ACO was established by the Patient Protection and Affordable Care Act (PPACA) Section 3022 mainly to better the quality of care to beneficiaries and to save money for Medicare (Golden). The accountable care organization is voluntary for provider participation and Medicare beneficiaries still can choose treatment from any provider they wish which is beneficial. The ACO has been viewed as a potential tool for rebuilding the traditional Medicare coverage according to Medicare Payment Advisory Commission known as MedPAC (Rosenbaum). According to CMS,

United States take pride in many things: world’s largest economy, strong military power, internationally acclaimed institutions, great cultural diversity, endless entertainment from Hollywood to Major League Baseball, and more. Unfortunately, health care did not make it into the list. It is quite unsettling to accept that 2010 health data for industrialized countries placed United States in the last place in almost every criteria. U.S. health care spending had reached $7,538 per capita which was far more than any other country, doubling the OECD median of $2,995 (Squire, 2). In the analysis of five-year survival and mortality rate for various forms of cancer, the data showed that the outcomes of Americans did not perform any better than

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

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

Accountable Care Organization (ACO) model, consist of health professional that form an affordable quality health care to those who have Medicare. These doctors, nurse and other join this team voluntarily, they contribute to this organization by hold relationship with the patient to configure the best care. The organization is designed to given the patient more “say so” into their own health/medical care. There is absolutely no catch to having the support of this organization, those are who have Medicare will remain in control over picking provider and other Medicare services. According to Niles (2018), “ACO’s is purely voluntary, and participating patients will see no change in their original Medicare benefits” (pg. 374). This service beings

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

Accountability has become an important field in the health care programs because it involves the events and procedures for not only mitigating but also taking responsibility for the actions taking place in an organization. This is crucial because how the funds are handled may directly affect how the patient is treated or the quality of treatment the patient gets. Accountability has also been known to have a robust influence on how one makes decisions. This has been proved true in the study of social cognition, organizational dynamics, and human interaction. This shows the importance of accountability in the health care systems and how the employee's accountability is measured. It is also important to analyze how the checks and balances procedure is like. Accountability also affects the organization's working culture hence the importance to maintain a good working culture and avoid one that is blamed in health care.