NUR 621 Topic 6 DQ 1
DQ In an accountable care organization (ACO), insurance companies are looking at how health care organizations care for a specific population
KNOWLEDGE CHECK
Discuss why population health has become a significant focus of the US health care system. In your opinion, what model is the best option to meet population needs? Present rationale.
REPLY
Accountable Care Organizations (ACOs) aim to provide well-coordinated, cost-effective care when clients need it. The accountable care model emphasizes population care, value-driven outcomes, emphasis on the point of service at which patient care occurs, protocols for effective hand-offs, and inclusion of the family in decision making (Weberg et al., 2020). The ACO provides Medicare beneficiaries with coordinated care at lower costs. ACOs share the triple aim to improve care for the individual, improve population health, and reduce costs. With the direct link between payment for quality care, providers must ensure the best-coordinated care and services every time, thus improving patient outcomes and population health.
Benefits of coordinated care include less medical errors, improved access to care, reduction in hospital readmission, and prevention of duplicate services. ACOs aim to improve population health by providing high-quality care to improve and maintain health by focusing on prevention and managing chronically ill patients (CDC, n.d.). ACOs are held accountable to patients and payers through a pay-for-performance model where providers share overall savings when population-based performance standards are achieved through quality care, and the costs savings are not at the expense of patient care or population health outcomes (Wilson et al., 2020). Policymakers have increasingly advocated for the ACO model because of the shift from volume-based care to value-based care and the emphasis on population outcomes (CDC, n.d.). ACOs will continue to positively impact patient care, patient experiences, patient outcomes, and population health and outcomes.
References
Centers for Disease Control and Prevention. (n.d.). Partnering with ACOs for population health improvement- CDC. https://www.cdc.gov/nccdphp/dch/pdfs/partnering-with-acos.pdf
Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in nursing practice: changing the landscape of nursing practice. Burlington, MA: Jones and Bartlett Learning. ISBN:9781284146530
Wilson. M., Guta, A., Waddell, J., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes, and costs: a rapid review. Journal of Health Services Research & Policy. https://journals.sagepub.com/doi/10.1177/1355819620913141
REPLY
Such a great conversation! Yes – we are spending most money on chronic conditions. Looking at alternative ways to manage are current issues is critical. ACOs is one way that integrates and coordinates care.
Many hospital systems are now integrated; this is being done for efficiency and profitability. Patients like the model because it is one
stop shopping. Health care systems like it because they have the ability to keep patients within their “arms” and not lose to the competitors. If you go to Mayo Clinic, for example, you spend a day there; however, you see ALL of your doctors and get your testing done in one day. Multiple appoints are coordinated for enhanced service.
Let’s focus on the independent primary care physician. This is one area that is left out the equation. Frequently these practices are not integrated into the system nor do they have access for coordination of care. This has been identified as an area of concern in terms of heath care reform.
Phillips, R.L., & Bazemore, A. W. (2010). Primary care and why it matters for U.S health reform. Health Affairs, 29(5), 806-810.
REPLY
DQ: In an accountable care organization (ACO), insurance companies are looking at how health care organizations care for a specific population
You did an excellent overview of Accountable Care organizations (ACOs). Under the Patient Protection and Affordable Care Act (PPACA), ACOs were created with the goal of transitioning from the traditional volume-based, fee-for-service model to a coordinated patient-centered health care delivery system (Lin et al., 2018). Lin et al. (2018), identified the Medicare Shared Savings Program (MSSP), which was authorized under the PPACA, as the framework for the Medicare ACO program. Kliethermes et al. (2019) described an ACO as a group of health care providers who collaborate to provide patient care and receive financial incentives based on quality and performance outcomes achieved. This model results in reduced health care costs, allows patients to receive services that are more streamlined and coordinated, and improves communication and engagement between the patient and their provider.
References
Kliethermes, M. A. (2019). Value-based payment: Preparing for changes in payment for services. Pharmacy Today, 25(9), 44-53. https://doi.org/10.1016/j.ptdy.2019.08.023
Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: DQ: In an accountable care organization (ACO), insurance companies are looking at how health care organizations care for a specific population
Lin, Y., Du, Y., Gomez, C., & Ortiz, J. (2018). Does patient-centered medical home recognition relate to accountable care organization participation? Population Health Management, 21(3), 188-195. https://doi.org/10.1089/pop.2017.0096
REPLY
Patient outcomes primarily depend on the approach that health care providers apply in health care delivery. Insurance companies also evaluate how health care organizations care for a specific population. As a result, health care providers should use models that promote timely care, reduce costs, and encourage coordination between providers.
Accountable care organizations (ACOs) are health care programs founded on coordination. Under ACOs, health care providers such as doctors and hospitals come together voluntarily to provide coordinated and high-quality care to their patients (Nathan et al., 2019). A suitable example of such a program is the Medicare Shared Savings Program. Initiated by the Centers for Medicare & Medicaid Services (CMS), the program brings organizations together to work towards meeting quality performance benchmarks (CMS.gov, 2021). The other goal is to coordinate care to reduce Medicare spending by a considerable margin so that the organizations under the shared savings program can qualify for sharing in the cost-saving schemes.
Health care under ACOs impacts the population’s health profoundly but, generally, positively. Under ACOs, the primary objective is to deliver value, timely care, and promote cost-effectiveness as much as possible. Mostly, health care providers do not promote timeliness if they do not coordinate. However, as Gross (2020) underlined, the coordinated practice guarantees the population better health outcomes, including timely and value-based care. Health care services are also available when needed, reducing the access problem. Importantly, the urge to minimize spending enables ACOs to reduce wastage in health care delivery. A coordinated approach also prevents service duplication.
As health care providers work towards meeting 21st century needs and benefiting more from insurance reimbursement, they need to adopt health care models that enhance efficiency. They also need to collaborate more and promote cost-effective care. ACOs improve care coordination to reach quality improvement goals. Providers under ACOs qualify for sharing in the savings when they meet the set performance benchmarks, which is easier under coordinated care.
References
CMS.gov. (2021, Mar 4). Accountable care organizations (ACOs).https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO#:~:text=What%20is%20an%20ACO%3F,care%20to%20their%20Medicare%20patients.
Gross, P. A. (Ed.). (2020). Pathways to a successful accountable care organization.Johns Hopkins University Press.
Nathan, H., Thumma, J. R., Ryan, A. M., &Dimick, J. B. (2019).Early impact of Medicare accountable care organizations on inpatient surgical spending. Annals of surgery, 269(2), 191-196. https://doi.org/10.1097/SLA.0000000000002819
REPLY
Constantine, excellent post – we are in an interesting time, regardless of setting. The “Patient Experience of Care” is a focus of Medicare. Historically, the Centers for Medicare & Medicaid Services (CMS) paid what they were billed. Health care organizations were not held accountable and our health care costs grew dramatically. We are now sophisticated in the use of data collection and analysis. Organizations that obtain better outcomes are paid more; organizations that do not are paid less. CMS has stopped paying for conditions that are deemed preventable.
Now we add in the patient – CMS wants to engage the population in selecting organizations that do better. In addition, feedback is being requested.
It is a fine balancing act for leaders – efficiency, quality of care, and patient experience of care may be at odds.
Class – how are your organizations working on the patient experience?
Centers for Medicare & Medicaid Services. (n.d.). What is the patient experience of care survey? https://www.medicare.gov/HomeHealthCompare/Data/HHCAHPS-Overview.html
REPLY
Thanks Professor Hale for the post!
“Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility” (Manzoor et al., 2019). To better my organization a couple years ago when we were re-branded into one organization with our sister hospital, the organization sent all employees (physicians, nurses, therapist, secretary, janitors, dietary, volunteers, etc.) from all departments, units, clinics, hospital, etc. (basically anyone that was employed and/or volunteered under our organization) to a customer service training seminar/classes. During these classes we were all educated and taught the importance of presenting, educating, and going up and beyond our job expectations with every patient and team member (employee) encounter within our organization. This has not only increased the moral of the organization but has also really increased our patient satisfaction and HCAHPS scores. All new employees have this training incorporated within their new employee orientation. With the three goals of providing the HCAHPS surveys are to motivate hospitals to improve their quality of care in patient satisfaction; provide transparent public reporting of the results of the surgery; and to allow consumers to compare hospitals objectively (Tevis et al., 2015). From my organization mandating the customer service training classes that they did and currently still do, it has a positive impact within our organization as well as within the communities our organization resigns in. Patients speak very highly about our organization and know that they will receive outstanding safe quality of care within their encounters when choosing our organization for their health care needs and our HCAHPS scores reflect this.