Accountable Care Organizations Essay
What are your thoughts about the emerging accountable care organizations? In what ways do you think they will affect the current health care delivery system? How do you think the practice patterns of primary care physicians will change under the new models of health care? What are the biggest problems that this could bring to primary care practices?Accountable Care Organizations Essay
Emerging Accountable Care Organizations have promoted inter-collaboration between hospitals, nurses, physicians and other healthcare providers in ensuring co-ordinate d healthcare services and high quality care. Besides, they have significantly enhanced the performance of healthcare organizations since the payments made to healthcare providers are linked to the value and quality of care provided rather than the volume. ACO is one of the best form of approaches to healthcare that prevents medical errors and the duplication of services. They cater for the patients’ needs as well as those of healthcare providers through flexible reimbursement models that focus on value, safety and efficiency for quality health outcomes.
In the current healthcare system, ACO will progressively enhance quality improvements in the care provided to patients through co-ordination efforts, promoting the use of Health Information Technology and direct engagement of clients and close family members as partners in the process of decision making (Bard & Nugent, 2013). Under the new models of healthcare, primary care physicians will be required to be part of an ACO to receive Medicare benefits. Alternatively primary care physicians will need to co-ordinate a patients care with specialists, hospitals, private or public health payers. This can be attributed to the fact that ACO focus more on strategies that improve the delivery of care as compared to direct reduction of costs (McGinnis & Small, 2013). Alternatively, another strategy for primary care physicians is the sharing of benefits based on priority listings in case of inadequate savings, which is flexible and will enhance sustainability in the provision of care.Accountable Care Organizations Essay
The biggest challenge from ACO would arise from operational technicalities such as deciding the specific methods to be used in assigning patients to a particular ACO, how to allocate/share savings and methods for risk adjustment.
References
Bard, M., & Nugent, M. (2013). Accountable care organizations: Your guide to design, strategy,
and implementation. Chicago, Ill: Health Administration Press.
McGinnis, T., & Small M D., (2013). Accountable care organizations in Medicaid: Emerging practices to guide program design. Center for Health Care Strategies, Inc.
What I would say, having you know, spent some time pre ACOs, visiting and learning from the integrated delivery systems like Kaiser Permanente and Group Health and Geisinger and many others besides in the States, is that you’ve seen one ACO, you’ve seen one ACO. But if you look across the family of ACOs, what you see is some common and important ingredients and they’re the ones I have listed on this slide here.
When you look under the bonnet of ACO you see these kinds of things, and this is not new to us, is it? We’ve been working on these issues at least for ten years and probably longer since there was a growing understanding about the shifting burden of disease, the increasing importance of chronic conditions, the issues around age in populations and frailty, and where are the biggest opportunities? Well, understanding the population being served and stratifying by risk. Using case management to support people with complex needs. Improving flow in hospitals, by using hospital lists and discharge planners, increasing the news and of course, following up post discharge to maintain contact with patients and to ensure they are in good health in their own homes. Not forgetting expert patients, supporting people around self-management and indeed shared decision making.
If you want to try and save the eye watering sums of money that the NHS in England is required to save, you’ve got to understand where the money is and we’ve got to focus on acute hospitals in the NHS because that’s where the money is. An opportunity may be through some of these mechanisms to shift care delivery out of acute hospitals into alternative settings by doing these things systematically but this is the sociological bit, the hard bit. How can we do that in England? We have a system that fundamentally was setting up the legislation to promote competition between organizations, as sovereign bodies and we’re now asking leaders to forget some of that and be good corporate citizens and to collaborate in the development of ACO type models of care.
Using a non-US example, and some of your will have heard the story of the Canterbury Health Board before, I think it’s a very powerful story and a very different jurisdiction, much more similar to England than the United States. Their vision of Canterbury having one system, one budget, I think has a powerful set of evidence about what can and should be done to move from organizations to systems, from SILO budgets to one budget and to get the collaboration alliances, as they talk about in Canterbury, on which their success in integrating health and social care is based. Accountable Care Organizations Essay
It’s just a huge amount of effort going into thinking about the governance and the organizational form in the ACOs that we see emerging through the Vanguard program me. That’s understandable, it’s necessary, it’s important but if you simply put in place new governance and new organizations without a strong underpinning around the relationships between the organizations and their leaders and their clinicians involved in these provider partnerships, frankly you are setting yourself up to fail.
So, talk to the lawyers but also think about how you can move beyond competitive behaviors, the collaborative behaviors, from organizational leadership to system leadership.
And this is a slide I borrowed from Michael West, one of our colleagues here. Michael’s a psychologist by training and he says there are five golden rules if you want to build collaborative relationships and these are they. You’ve got to have frequent personal contact with the people you want to collaborate with. Going to a partnership board once a month or even worse, once a quarter, and expecting that to develop into collaborative system relationships is a route to disaster. It’s about being in it for the long term. This is about how you collectively, in your county, your borough, your city, plan to work for the next five, ten, fifteen years, based on a shared purpose and shared vision.
It’s about being able to surface and resolve conflicts because there will not always be agreements, there will often be legitimate differences about how the money is used and how you deal with say, overspending in acute hospitals when you’re trying to achieve parity of esteem for mental health or investing in under-invested primary care services, and it’s moving beyond self-interested behavior which a competitive market assumes, to behaving altruistically.
So the conversation is about how can I help you in the mental health trust or in primary care, deliver on your priorities and how can we work together, not how can I simply adopt the fortress mentality and look after my organizations budget and its performance.
So the key message from me really is about marrying this emphasis on relationships and cultures and collaboration with an understandable focus on governance and structures and organization form which is a strong message from the report we published today.
This brief video captures some of Dr. Pratomo’s views on the importance of the ACO model within a performance-based healthcare system.
Performance-Based Medicine is Ethos of Accountable Care Organization
By John Henry Dreyfuss, MDalert.com staff.
- Accountable care organizations (ACOs) embody performance-based medicine.
- An ACO is a network of healthcare providers and hospitals that shares responsibility for providing all types of healthcare to ≥5000 Medicare beneficiaries at a period of at least three years.
- These providers and organizations must be able demonstrate that they can reduce costs while improving outcomes.
- Studies have shown that ACOs do effectively achieve these improved results.
The ACO
The concept of the accountable care organization (ACO) evolved with the theory that high healthcare costs result from a fragmented, pay-for-volume system, and that transitioning to coordinated care will reduce healthcare costs without compromising quality.
The structure of the modern accountable care organization (ACO) was first proposed by the Centers for Medicare and Medicaid Services. Today, performance-based medicine is at the heart of every ACO. ACO members work continually to improve the quality of care and reduce the cost through care coordination. They also strive to optimize the patient experience by keeping the patient at the center of the coordinated care team. Accountable Care Organizations Essay
Physician Experience
An ACO is primarily intended to provide multimodal care by a team of healthcare providers, all of whom are focused on the patient.
“Putting the patient first is really the goal of medicine,” Vanessa Pratomo, MD, told MDalert.com. “The ACO model allows all members of the provider team to remain focused on the patient and the patient to remain at the center of the team’s care.”
Dr. Protomo is a primary care physician and an expert on ACOs. She is a member of the staff at Montefiore Medical Center in Bronx, NY. Montefiore is a very successful ACO model in New York City.
By placing the patient at the center of care of a multimodal team, the ACO embodies performance-based medicine. “This idea of performance-based medicine … has been going on years. We just have new names for it.”
With changes at CMS and financial incentives for operating an ACO, the old ideas of healthcare have been paired with government muscle in the form of additional funding.
Dr. Pratomo does not see the ACO model as a new philosophical approach as much as a new business model. “I think it’s what a lot of doctors imagined a good doctor was when they were growing up. It’s what every doctor thinks a good doctor is.” Now doctors can be additional reimbursed when they practice the way they’ve always thought was the right way.Accountable Care Organizations Essay
History of the Accountable Care Organization
While many healthcare professionals talk about accountable care organizations (ACOs), few can describe one in detail. The ACO is a business and healthcare model that has been promulgated by the Centers for Medicare and Medicaid Services for some time. Essentially, an ACO is a network of doctors and hospitals that shares responsibility for providing complete healthcare to no fewer than 5000 Medicare patients for a period of no less than 3 years.
With the aging of the U.S. population, increasing costs of healthcare, and increasing national deficit, controlling Medicare costs has become a prime target for federal lawmakers. Past efforts to consolidate healthcare have included Health Management Organizations (HMOs) and Integrated Delivery Networks.
The term accountable care organization was first presented in 2006 during a Medicare Payment Advisory Commission (Med PAC) public meeting convened to discuss alternatives for physician payment models to replace the Sustainable Growth Rate (SGR) formula. Proponents of the ACO model believe that traditional, fee-for-service healthcare will eventually be replaced by population-based payment models that promote preventive healthcare and discourage overtreatment.
The ACO is proposed as a network of healthcare providers assuming joint responsibility and accountability for reducing costs and improving outcomes in a defined patient population. Formation of an ACO requires capital expenditures that create and infrastructure that promotes high quality and efficient care. An ACO must have a legal structure that allows participating physicians to receive and distribute incentive payments. It must use a patient centered process of care and be capable f reporting quality measures. In its original definition, the ACO was proposed to include a variety of provider configurations, including physicians and hospitals, anchored by primary care.7 In contrast with HMOs, the ACO model is designed to achieve cost savings through improved care quality rather than restricted utilization of services.Accountable Care Organizations Essay