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).
NURS 8100 Discussion Unintended Consequences of Health Care Reform
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.
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. The healthcare payment process is undergoing a dramatic transformation as payers and providers shift from volume to value. While stakeholders are currently piloting many different value-based care models, accountable care organizations are among the most popular and successful strategies to date. Accountable care organizations, or ACOs, are groups of hospitals, physicians, and other providers who agree to coordinate care for patients and deliver the right care at the right time, while avoiding unnecessary utilization of services and medical errors. ACO participants also agree to take on responsibility for the total costs of care for their patients. ACOs that reduce the total costs of care for their patient populations can share in the savings with the payer. In certain models, they may also be liable to pay back losses if their costs exceed their spending benchmarks (Moore et al., 2017). Policymakers and healthcare leaders believe tying financial incentives to care quality, patient outcomes, and care coordination through ACOs is a key solution for fixing the inefficient fee-for-service system. The programs encourage providers to partner with others across the care continuum. Some providers are formally acquiring to gain control over a wide range of services, achieve economies of scale, and access the technology, data, and clinical capabilities of their peers. In fact, ACOs are and are likely to continue to be a major player in the value-based care and payment transformation. When all the parts work together, providers in an ACO can bring down costs and improve care quality while earning incentive payments. HMOs, on the other hand, seek to cut costs by setting fixed prices for services, which may encourage providers to reduce utilization or skimp on care in an effort to stay under the cap(Colla et al., 2018).
References
Colla, H., & Fisher, E. S. (2018). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122
Moore, K. D., & Coddington, D. C. (2017). Accountable care the journey begins. Healthcare Financial Management, 64(8), 57-63. Retrieved from https://www.proquest.com/trade-journals/accountable-care-journey-begins/docview/746684537/se-2?accountid=14872
Response
This is insightful Edwige, Bottom of FormAccountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers who come together to provide coordinated care to their patients (Colla & Fisher, 2018). The goal of ACOs is to improve the quality of care while also reducing costs. One way that ACOs achieve this goal is by sharing information about their patients (Meyer et al., 2017). This allows the providers in the ACO to work together to come up with a plan for each patient that meets their individual needs. ACOs can also use this information to track how well they are meeting quality and cost goals (Lewis et al., 2019). ACOs are funded in part by Medicare and Medicaid. However, they are also open to patients who have private insurance. ACOs have been shown to improve the quality of care while reducing costs. For example, a study published in Health Affairs found that ACOs were associated with improvements in quality of care and reductions in spending on Medicare patients.
References
Colla, H., & Fisher, E. S. (2018). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine, 177(4), 527-528. https://doi.org/10.1001/jamainternmed.2016.9122
Lewis, V. A., Schoenherr, K., Fraze, T., & Cunningham, A. (2019). Clinical coordination in accountable care organizations: A qualitative study. Health care management review, 44(2), 127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461217/
Meyer, C. P., Krasnova, A., Sammon, J. D., Lipsitz, S. R., Weissman, J. S., Sun, M., & Trinh, Q. D. (2017). Accountable care organizations and the use of cancer screening. Preventive medicine, 101, 15-17. https://doi.org/10.1016/j.ypmed.2017.05.017
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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
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Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource