The State Shifting care accountable organizations
ACOs consist provider groups -. Large hospital systems to small physician practices - that cooperate to coordinate care and share the costs for a certain population. the COA members use their pooled resources to increase efficiency and quality of care while reducing overhead and redundant costs. To qualify as an ACO, an organization must (a) defining the reporting process quality, cost and coordination of care, (b) have a formal legal structure to distribute bonuses to participating suppliers and (c) have primary care responsibilities for at least 5,000 Medicare beneficiaries. ACOs are encouraged under the Patient Protection and Affordable Care Act (PPACA) and incentives and health insurance premiums Shared Savings Program, based on respect of care quality criteria.
ACOs can take many forms. The rules of Medicare Savings Program ACO Shared deliver results and performance measures for ACOs but little structure regarding leadership and outside what is stated above. COA Administrators have the ability to use different approaches to achieve the right balance between expenditure control and quality care to their suppliers and consumers.
Potential Benefits and Challenges
The ACO movement is growing rapidly as more providers are moving delivery models of care centered on the patient. Many stakeholders are carefully watching how the early adopters of ACOs navigate the challenges and risks of this new structure before entering the scrum
Benefits :.
- patients and insurers will see the increase in favorable outcomes, lower costs and fewer errors.
- suppliers will have more leeway in their quest holistic care team for patients.
- Because payments will be for the results, not by the service, the practice of using team approaches will not see their reimbursements decrease.
- administrators will be able to justify and information technology on the lever of capital (IT) and infrastructure projects.
challenges
- physicians should feel the benefits of pooled resources and better outcomes outweigh the legal risks and threats to their traditional independence. They will also have to forge new partnerships and collaborations with other doctors.
- ACOs must create an infrastructure to manage risks such as electronic health records (EHR) and information systems, medical management protocols and tactics to monitor patient compliance.
- ACOs face more financial and administrative headaches, such as contracts with health plans and the collection and distribution of payments.
- The benefits of coordinated care must be sold to consumers. Currently, patients can choose from a COA and still see physicians outside the ACO, as there is no restriction on the choice of supplier, as there are in Health Maintenance Organizations (HMO).
What is a successful ACO?
The jury is still out on whether ACOs are here to stay, and each community and partnership will be different. But experts agree that there are some common factors that are likely to be present in ACOs success:
- Flexible, effective leadership with the ability to develop strong teams, culture, priorities , innovation and communication
- Clear governance to execute strategy, management strengths, improve challenges and put profits wisely
- talented workforce with the ability maximize productivity, control of fixed and variable costs, manage relationships and deliver coordinated care
creating an effective ACO has clear challenges, and effort associated with the configuration is important. No doubt the experience of managers and administrators will be critical to the construction and execution ACOs. These directors will allay the fears of providers regarding changing risk structures, payment patterns and changes in daily activities while creating a culture that promotes better outcomes and patient experiences.
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