Accountable care organization is composed of a group of care providers, hospitals, and doctors who join up collaboratively together to provide high-quality care to the patients. The goal of an Accountable Care Organization is to ensure that they provide coordinated care to the patients ensuring that the chronically ill especially will get the right care at the right time while avoiding unnecessary services duplication as well as preventing medical errors. The rate of healthcare spending is expected to rise by 6 percent every year by the end of 2020 in the United States (Devore & Champion, 2011). By the period, the health care spending is expected to account for about a fifth of the country economy and the federal government will be expected to pay a greater share in financing the health care cost ever than before.
In the recent days, there have been reforms in the Medicare federal programs changing the way the healthcare is paid for and organized. Recent rules have stipulated a new path for hospitals, doctors and other healthcare providers to form teams referred to as “Accountable Care Organizations” that are essential in saving money through coordination of medical care services for the patients. Under the reforms, the teams are expected to provide health care at a lower cost treating the patients for lesser money. The government has committed to rewarding such organizations financially if they meet the expected quality measures (Lieberman & Bertko, 2011). Development
An Accountable Care Organization is a form of managed care that differs from the health maintenance organizations. They are normally run by doctors, a group of health care practitioners or hospitals rather than by the health insurance companies. In order to qualify for an Accountable Care Organization, the group, hospital or doctors must have an ability to provide primary care for at least 5000 patients or more (Devore & Champion, 2011). According to Greaney (2011) an Accountable Care Organization can be defined to be a set of health care providers that include specialist, primary care physicians and hospitals who work in Unisom to accept the collective accountability for quality and cost of care that is delivered to the patients. It can be developed around a variety of existing types of organizations. A number of multispecialty medical groups, integrated delivery systems, and physician hospital organizations are already functioning as Accountable Care Organizations or have their management structure evolved as that of an Accountable Care Organization.
Other organizations providers such as the independent practice associations have transformed to Accountable Care Organizations while other are acquiring more infrastructure support in an effort of providing cost benefits and care as ACO’s. The Affordable and Care Act has the most significant contribution to the creation of Accountable Care Organizations through the traditional Medicare fee for service system. Through the platform, it allowed the Medicare to reward health care providers with a share of their savings resulting in enhancement of care quality as well as a reduction in the health care cost to their eligible Medicare populations resulting to the development of Accountable Care Organizations (McClellan, McKethan, Lewis, Roski, & Fisher, 2010). Health Impact
Accountable Care Organizations seek to tie health care provider reimbursements to the quality care provision, as well as a reduction in the total cost of care provision to the patients. The organization works with one or more players most commonly the Medicare in the attainment of a triple aim of enhancing the population health. It has a goal of enhancing the patient’s experiences during care delivery as well as reducing the cost of care delivery. A successful Accountable Care Organization needs to be composed of an empowered team of primary health care providers with the necessary information, resources and leadership to be able to coordinate and manage patients care across the community (Burns & Pauly, 2013). The Accountable Care Act, health care model, is part of the patients Affordable Care and Protection Act thus; organizations main goal is the provision of high-quality care to improve health care delivery system in the country in enhancing patient’s care.
In enhancing quality measures of care provision the Center for Medicare and Medicaid Services has developed domains of evaluating the quality of Accountable Care Organizations performance that entail care coordination, caregiver safety, patients experience, preventive health as well as the at-risk population health. In this regards an ACO needs to ensure that it provides the best experience of health care to the patient, enhances the patient’s safety, coordinates health care delivery effectively and offers preventive health especially to the risk population such as the elderly (Fisher & Shortell, 2010).
However, according to Harry & Kristina (2009) given the complexity of the existing health care system, these organizations will not only fail but also they are likely expected to exacerbate the problems further rather than fixing them. This is because they only concentrate more power in fewer organizations thus, letting them to become too large to fail. Under such a system, there will be little entrepreneurship and competition that usually form the bases of job growth and innovation in the system. Moreover, no evidenced has been based in support of the utilization of the complex organizations structures in improving quality care delivery as well as reducing health care cost. Economic Impact
An Accountable Care Organization is involved in saving money for the payer with any element of compromising the quality of care delivery, and it shares in the savings. The facilities part of ACO places a high degree of financial responsibility on it providers with hopes of enhancing the care management as well as limiting unnecessary expenditures during the provision process as it continues to provide the patients with freedom of selecting their own medical services (Bennett, 2012). The key to the attainment of success is the achievement of clinical excellence while at the same time controlling the cost of healthcare provision through coordination enhancement. Through an increase in care coordination, these ACO are essential in reducing unnecessary medical care cost and enhance health care outcomes of the patients saving the government about $470 million by 2016 (Hacker & Walker, 2013). Thus, the federal government will be able to reduce in its health care spending to focus on other areas of development with the provision of quality care to the patients. The Future
Accountable Care Organizations form an essential part of the future in health care delivery and for all family physicians. Already nearly, 400 ACO’s have been established and still more are underway (Nissenson, Maddux, Velez, Mayne, & Parks, 2012). Of these around 260 of them are participating in the Medicare Shared Savings Program while the rest are commercially developed ACO’s. These health care organizations are already becoming pervasive and are on a way to the development of an efficient and effective care system in the country. Among the challenges faced by ACO’s is that their primary goal is reducing hospital stay, hospital visits, and expensive services that are the ways that hospitals and the physicians make money. However, despite the challenges faced, Accountable Care Organizations are part of the future of health care in the United States. However, it is difficult to determine their success in the long run. (Burns & Pauly, 2013) Their potential of enhancing quality care with reduced cost to better the lives of their patients makes them quite a serious consideration even in the future. Conclusion
An Accountable Care Organization is a form of managed care that differs from the health maintenance organizations in that they are normally run by doctors, a group of health care practitioners or hospitals rather than by the health insurance companies. The primary goal of Accountable Care Organizations is ensuring that they provide coordinated care to their patients ensuring that patients get the right quality care at the right time while avoiding unnecessary services duplication as well as preventing medical errors in an effort of reducing the heath care cost. With the expected increase in health care expenditure by the government, Accountable Care Organizations are playing a great role in reducing the expenditure and are expected to be part of the future health care system in the country.
They are merely the latest developments currently introduced in the long history of the health policy. Since 1970, the government has promoted a number of mechanisms to help in controlling the increasing health care costs such as the introduction of Medicare payments formulas that were based on fixed payments for hospital services as well as the introduction of health maintenance organizations and preferred provider organizations. Despite the developments, health care costs have been on the rise with concerns about poor and diminished care provision. The Accountable Care Organizations have been viewed as a remedy of correcting the system.
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