What The Accountable Care Organization

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

An ACO are groups of healthcare providers who work together to provide cost efficient care for Medicare patients. Nurses will help an ACO by functioning as a care coordinator of Quality Improvement Manager. Care coordinators will have to manage care with doctor offices, hospitals, rehab centers, and home settings, Quality Improvement Managers will focus on analyzing data and promoting evidence based practices.

Such mechanisms are hardly a novelty or cutting edge innovations. Such operational strategies are not much different from those used by their predecessors. Why should anyone expect more success just because the 3-letter name of this managed care group changed? ACOs are simply attempting to replicate the performance of HMO in holding down the cost of care while avoiding the features that gave the HMO control, and hence its success, and created a consumer backlash in the 1990s. However, unlike HMOs, the ACOs must meet a long list of quality measures to ensure they are not saving money by being frugal on necessary care. Patient trust in the ACO model is not well established. To earn patients’ trust, they will need to prove their value.

Ultimately, these regulations of the ACA have effectively solved many inefficiencies within the healthcare system. One of the biggest problems was the large amount of government spending due to Medicaid. However, the Accountable Care Organisation

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).

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 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.

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

Providing enhanced access to a better quality health care system is reliant upon the identification and modification of various barriers, which must be addressed. Complex health care systems and politics generate barriers to the delivery of high-quality access to care through knowledge deficits. Consumers are tasked with understanding what services are needed as well as their abilities comprehend their diagnoses are challenged. They must also over come barriers to communication to converse effectively with caregivers. Most importantly, they must understand their role in the process as patients and citizens when accessing health care services. (Ricketts, 2013) Comprehensive provisions built into the ACA help to energize endeavors aimed towards developing ways to ensured enhancements to the quality and access to health care provided in North Carolina. Accountable care organizations (ACO) were

Providers could shape these ACOs willingly. On the other hand, they could be practical ACOs acknowledged during analysis of claims data showing shared use of medical services in a population served by hospitals and their medical staffs (Fisher, Shortell, Kreindler, Van Citters, and Larson, 2012).

​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).

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

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.