Accountable Care Organizations

Accountable Care Organizations

Accountable Care Organizations

By definition, an accountable care organization (ACO) is a group of health care providers that work together to coordinate and manage care for a specific patient population. As part of managing care for the population, the ACO takes responsibility for improving the quality of the care being provided while simultaneously reducing costs. ACOs can include different types of providers that are not part of a specific health network. For example, the ACO model provides incentive for two hospitals that were not previously affiliated to join forces to achieve the same goal: improve the quality of healthcare while reducing the cost (Swidey, 2011).

The ACO model differs from the current fee-for-service model that is widely used today. Fee-for-service arrangements reimburse doctors and hospitals based on the quantity and type of services that are rendered.  For example, if a blood test costs $5 to perform, and the doctor receives $7 compensation ($2 profit), there is an incentive for him to order more tests (even if they are not necessarily needed) just to increase his revenue. In the ACO model, physicians and hospitals will be given a pre-determined amount of money based on each patient’s medical history and diagnosis. With this type of prepaid funding, it is expected that there will be a dramatic decrease in unnecessary tests, treatments, consultations, and hospitalizations (Gold, 2011).

According to the article A New Health Care Model, the concept of an ACO is very different from the types of payment systems that are currently in place. ACOs are intended to focus on providers and influence their delivery of care rather than focusing solely on insurance companies. They are also aimed at the consumers of healthcare, or the patients, by making them more conscious of their own health and healthcare plan coverage. Ultimately, ACOs have been designed to impact the entire healthcare delivery system, not just the payment stream associated with it (Swidey, 2011).

There are several key elements of the ACO plan that will change the way health professionals interact and how care is delivered. One element that will facilitate change in the system is the utilization of shared electronic medical records (EMRs). This will dramatically improve communication between provider networks and allow access to critical patient information. Other elements of the ACO plan include setting up incentives for those who successfully reduce the cost of care delivery while improving quality, facilitating communication and joint decision-making between healthcare networks, and encouraging patients to make better decisions regarding their own health and to become more actively involved in the healthcare system (Domrose, 2011).

Personally, I am in support of many aspects associated with accountable care organizations. As previously mentioned, I believe that they will be able to dramatically reduce healthcare costs and eliminate an enormous amount of waste in the system. I am very much in favor of making patients more accountable for their own health and lifestyle choices as well as educating the public about how the healthcare system operates. I believe that if ACOs are utilized as intended, the quality of care will increase because it requires physicians to operate using evidence-based, “best practice” research and methods. I also believe that sharing information such as patients’ medical records between healthcare networks is a key factor in improving care and quality while reducing time and costs.

However, I am cautious about the extent to which hospitals will go in order to reduce costs and save money. While eliminating unnecessary tests and treatments is a positive objective, I fear that it may become difficult for some patients and/or physicians to have access to certain tests because a patient may not meet every requirement listed in order for the hospital to be reimbursed. In other words, I fear that some hospitals may ultimately end up placing too many restrictions on tests and treatments that would negatively affect some patients in order to save money.

References:

Domrose, C. (2011, November 11). Hello acos. Retrieved from

http://news.nurse.com/article/20111107/NATIONAL01/111070036/

Gold, J. (2011, October 21). Faq on acos: Accountable care organizations, 

explained. Retrieved from

http://www.kaiserhealthnews.org/stories/2011/january/13/aco-accountable-

care-organization-faq.aspx

Swidey, N. (2011, February 11). A new health care model.

Retrieved from http://www.boston.com/lifestyle/health/articles/2011/02/06/a_new_health_care_model_what_will_acos_look_like_and_how_will_they_operate/.