Accountable Care Organizations, Essay Example

The government and many in the medical field have been trying to find ways to reduce the cost of health care for centuries. However, for many years, individuals in these professions have failed at doing so. Many have assumed that it is not possible to provide excellent care to patients and reduce the costs of health care at the same time. However, this is not the case. It can clearly be done and is being done more efficiently with Accountable Care Organizations (ACO’s). Accountable Care Organizations are helping many Americans afford healthcare and they are providing better healthcare to these individuals while doing so.

Accountable Care Organizations are networks where doctors and hospitals work together in order to provide care to patients so that they can limit the amount of money that patients are spending in order to receive healthcare. These individuals and hospitals share the financial burdens and the medical responsibility in order to provide patients with excellent care while also reducing the amount of money they have to spend in order to get that care (Gold, 2014). The key to providers making money and still reducing the costs of healthcare for Americans is for these providers to keep their patients healthy. Each patient has a primary care physician and sees that physician for most medical needs. ACO’s began at the heart of the Affordable Care Act that was enacted in 2010 by President Obama. Since then, specific provisions of the Affordable Care Act have made it possible for many young Americans to get healthcare coverage and have made many preventative care costs more affordable for Americans (“Reducing Costs and Improving the Quality of Health Care,” n.d.).

Accountable Care Organizations have many objectives. The most important objective is reducing the cost of health care for Americans. According to Gold (2014), many patients are getting their health services from multiple providers and this continues to be costly for them. Gold states that Congress included Accountable Care Organizations in the Affordable Care Act because they make providers accountable for the overall health of their patients and give them incentives for keeping financial costs down. The American Hospital Associations (2010) states:

Many experts believe ACOs in general will include certain core characteristics, including the participation of a diverse group of providers—including primary care physicians, specialists, and a hospital—and the ability to administer payments, determine benchmarks, measure performance indicators, and distribute shared savings (4).

“In addition, the Centers for Medicare and Medicaid Services (CMS) created a second strategy, called the Pioneer Program, for high-performing health systems to pocket more of the expected savings in exchange for taking on greater financial risk” (Gold, 2014, p. 2). According to Mark Merlis (2010), three key features of the program include invisible enrollment, performance measurement and shared savings. Patients “would not be formally enrolled, would not be required to obtain services through the ACO, and might not even know the ACO existed” (Merlis, 2010, p. 3). This would help payers define the population in which the ACO could be accountable for. The performance of the providers would be measured as well in order to determine how well their patient care has improved since they no longer have to worry so much about costs and paperwork. Finally, shared savings would be implemented in order to help providers with costs. Therefore, “if the ACO was found to have saved money, it would receive some share of the savings.” (Merlis, 2010, p. 3). However, in order to save money, the current models and key features of the program must be implemented and used accordingly.

According to Jonathan Blum (2011), there are three models or structures used in Accountable Care Organizations. These models include the Pioneer ACO Model, the Advance Payment ACO Model, and the Accelerated Development Learning Sessions. The Pioneer ACO Model is “designed to work in coordination with private payers, multiplying the effectiveness of the program and aligning provider incentives” (Blum, 2011, p. 4). By using this model, patients receive better health care and the costs are reduced. The Advance Payment ACO Model is made for those physicians who live in rural areas that would like to participate in the programs, but lack the resources to do so. The advance payments help the physicians because anything they owe is earned through their performance since the payments have already been received. Finally, the Accelerated Development Learning Sessions are there for any providers who are willing to learn more about the program and who are interested in becoming an ACO. The Innovation Center holds these free sessions in different cities and online in order for the providers to learn more about the requirements and necessary steps to become ACO’s and help them with the process. By providing these initiatives, the providers are able to focus less on money and more on the patients which deems the program a success.

Accountable Care Organizations can have a very positive impact on the reduction of health care costs while providing excellent care as long as the models are followed and advancements continue to occur to help providers. According to Blum (2011), payments to hospitals take up the majority of Medicare spending. However, CMS established the Hospital Value-Based Purchasing Program which ultimately changes the way in which hospitals are paid. This is how that program works:

Under the program, CMS will score hospitals based on their performance on each measure relative to other hospitals, as well as on how a hospital’s performance on each measure has improved over time.  CMS will use the higher of a hospital’s improvement and achievement score on each measure to determine a total performance score, which will then be translated into an incentive payment (Blum, 2011, p. 3).

By doing this, CMS will be able to determine which hospitals are continuing to provide quality care. CMS and the Department of Health and Human Services have begun the Electronic Health Records (EHRs) which enable them to focus on the patients more while eliminating the paperwork. Providers are able to communicate with each other more efficiently and this helps the patients get more one-on-one time with their doctors. As stated above, the key to providing excellent care is investing in innovation. Blum states:

The key to building a sustainable health care system in our country will come from innovations and improvements in how we deliver health care.  CMS has started this work by changing our hospital payment systems and Medicare Advantage programs to reward quality care and coordination, instead of simply paying providers for offering more services (6).

It is truly possible to continue to provide quality care and reduce the costs of health care at the same time. However, providers have to be willing to participate in the programs that are being offered to them. They have to be willing to take the time with their patients. They have to be willing to utilize all aspects of the plan, other providers, and their support systems. Many Americans have saved so much money already and this can continue. It takes effort, hard work, vision, passion and implementation, but it is possible. The more providers who utilize the resources set in front of them, the easier it will be to continue providing excellent care.

References

American Hospital Association. 2010 Committee on Research. AHA Research Synthesis Report: Accountable Care Organization. Chicago: American Hospital Association, 2010.

Blum, J. (2011, November 10). Improving quality, lowering costs: The role of health Care delivery system reform. Retrieved from http://www.hhs.gov/asl/testify/2011/11/t20111110a.html

Gold, J. (2014, April 16). FAQ on ACOs: Accountable care organizations, explained. Kaiser Health News. Retrieved from http://kaiserhealthnews.org/news/aco-accountable-care-organization-faq/

Reducing costs and improving the quality of health care. (n.d). Retrieved from https://www.whitehouse.gov/sites/default/files/docs/erp2013/ERP2013_Chapter_5.pdf