Accountable Care Organizations (ACOs)
Today’s rapidly evolving health care landscape requires hospital systems and providers to make significant efforts to adopt a culture of quality improvement and accountability. An Accountable Care Organization (ACA) consists of a voluntary group of providers responsible for the quality and cost of care for a defined group of patients throughout the continuum (Moore & Coddington, 2010). In 2012, Medicare introduced the Accountable Care Organization Program after the passage of the 2010 Patient Protention and Affordable Care Act (ACA) (Gold, 2015). The central concept of an ACO is shifting to a new payment model that supports value-based care. In addition, an ACO urges health systems and providers towards an integrated care model with shared financial risks ( Boddenheimer & Grumbach, 2020).
Benefits of Accountable Care Organizations (ACOs)
Under this reimbursement model, hospital organizations, physicians, and other care providers receive incentives for eliminating barriers to care coordination and managing costs (Boddenheimer & Grumbach, 2020). Additionally, they qualify to share in any savings generated from meeting quality and performance goals, including cost containment (Boddenheimer & Grumbach, 2020). Another benefit is that an ACO may elect to retain the majority of the shared savings when the actual cost of care is less than the projected budget. In contrast, they must refund Medicare should the actual care costs exceed the financial benchmarks (Boddenheimer & Grumbach, 2020).
A Disadvantage of Accountable Care Organizations (ACOs)
Although the concept of ACOs stems from integrating value-based care to address numerous silos in the healthcare delivery system, one disadvantage is the potential for restricting necessary care due to the economic implications imposed on health care systems and providers under an ACO ( Boddenheimer & Grumbach, 2020).
Challenges in Implementing Accountable Care Organizations (ACOs)
A critical component of implementing the ACO framework is obtaining provider buy-in to work together in creating meaningful change in care delivery (McClellan et al., 2010). Additionally, it is essential to establish the required number of eligible patients to sustain an ACO model (McClellan et al., 2010). Another challenge is the organizational readiness for change in fully implementing an ACO (McClellan et al., 2010).
In my practice, which is part of an extensive academic health system, the success of adopting the ACO model is due to the shared goals of everyone to provide high-quality patient-centered care, especially from the leadership of the organization. The presence of primary physicians, specialists, nurses, health IT, and other resources facilitates care coordination and eliminates waste. In addition, the active participation of physician leaders in collaboration with nurse leaders and other disciplines underpin the collective efforts of everyone to provide quality care throughout the continuum.
References
Boddenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach
(8th ed.). McGraw-Hill.
Gold, J. (2015). Affordable Care Organizations: explained. Kaiser Health News.
http://kaiserhealthnews.org/news/aco-accountable-care-organization-faq/.
McClellan, M., McKethan, A.N., Lewis, J.L. & Fisher, E.S. (2010). A national strategy to put
accountable care into practice. Health Affairs, 29(5), 982-990.
Moore, K.D. & Coddington, D.C. (2010). Accountable care: The Journey begins. Health Care
Financial Management. 64(8), 57-63.
