Accountable care organizations (ACOs)

Accountable care organizations (ACOs)

Introduction

Accountable care organizations (ACOs) are a new policy that has been developed to provide affordable and quality healthcare. The strategy is aimed at reducing the cost of medicare, improved quality of medication, and general good health to the public. Hospitals under the accountable care organization share the repercussions which are concerned with the patient outcome and the expenditures. The ACOs enter into a contract with the payer amount, which is used during treatment purposes. The organization helps in the provision of improved healthcare, reduced cost, and better healthcare.

The public and private healthcare have] adopted the accountable care organization to improve the quality of health by making it affordable to the clients. The medicare shared savings program enables the clinicians to provide improved healthcare to the patients. The policy has improved the healthcare sector inclusive and affordable to the people.

For example, in America, it has over five million subscribers who have joined the organization. The health reform has been backed up by many people through the benchmarked contract. However, some limitations encounter the success of the organizations to thrive well — the challenges cut across the ethical behavior and the organizational structure of the health facilities. For instance, there is an unconscious provision of incentives that are not well structured. The challenges will be discussed in the policy memo to establish the main problems encountered.

The organizations have also contributed to great merits in the healthcare sector. For example, as mentioned earlier, the decreased healthcare, improved healthcare, and quality medicare to the patients. The memo will also discuss the recommendations which, when put in place, will make the organization thrive forth while in providing affordable and quality healthcare.

Background

The program currently has 744 organizations, both private and public sectors in America. The healthcare program was pioneered by President Obama, who revived its performance since it had backslid in the 19th century. The accountable care organization was even constituted in the American constitution to provide financial incentives to the people who cater both the treatments, especially for the chronic and terminal diseases.

The health practitioners and hospitals under the program are paid for each test and procedure they carry out. It’s a mechanism of providing rewards to the practitioners and providing a sense of motivation to them. Doctors and hospitals are supposed to meet specific qualities for the benchmark in preventing chronic diseases. The incentives are made to motivate doctors in providing better healthcare and ensuring the mortality rate is low.

The organization is obliged to meet set conditions by ensuring that the provision of the services is provided as constituted. Malpractices by the doctors should not arise as they limit the success of the ACOs. According to Weissert, W.G, and Weissert, C.S. (212), explained that medical malpractices occur when practitioners cause harm to the health of the patient. He proposed that the cause is due to the neglect or oversight by the doctor. For the malpractices to occur, the doctor and the patient should have entered into relation when it happened. Secondly, the patient is expected to define how the breach of the healthcare standards occurred to assist in the petition. Thirdly, the effect of the violation of the care is determined whether it caused injury to the patient and, finally, if so, what did the resulting damages occur. Therefore, management ascertains if a breach of healthcare occurred and if it was the patient is supposed to be compensated for the injury happened. Thus with ACOs, such malpractices will not occur since there will be quality health provision. ACO designs are illustrated in the following diagram.

Evidence

The literature for the memo was extracted from the Weissert, W. G. & Weissert, C. S. (2012). Governing health: The politics of health policy (4th ed.). Baltimore, MD: Johns Hopkins University Press. Book chapter 6 and other clinical articles.

Problem facing ACOs

The challenges involved will involve the management, the patient’s decision, and the clinicians. The leaders pose management challenges. They have obligations to provide better healthcare to patients and society. Problems associated with leaders include the following; the first one refers to resource allocation. The ACOs are faced with the best method to allocate resources relative to the different conditions affecting patients. For example, some chronic diseases such as diabetes require trade-offs to allocate resources better. Some health complications require more funds than others.

Finding the exact amount to allocate to different diseases poses a significant challenge to the leaders. Therefore, leaders are supposed to make decisive approach before allocating resources to ensure accountability and transparency prevails. The savings are the core determinant of how they are supposed to be shared among different clinicians. Patients sometimes share their savings with the clinicians if it happens, the ACOs should advise the patient on the incentive program, which should be ethically carried out to avoid high incentives to a particular clinician.

Secondly, the ACOs are faced with the challenge of controlling the professional code of obligations. For example, diabetic and cancer patients require great referrals to manage the condition. If the clinician opts to reduce the cost of healthcare by lowering the references of the patient, the ACO will have done contrary to the patient’s ethics. It affects the health of the patient posing more significant harm to the patient.

Thirdly, the development of just decision-making approaches faces ACO performance. Leaders are faced with challenges in making sound decisions, especially in the ethical allocation of resources. The sound agreement between the ACO leaders and the medicare beneficiary should promote the health decision-making approach to control further challenges that might occur.

The second portion of the challenge might be attributed to the ethics of the clinicians. Professional autonomy of the health practitioners sometimes infringes professional freedom when they act contrary to the patient’s interest in the provision of quality health care. For example, the clinicians might decide the patient interventions to benefit at the expense of the patient.

Secondly, practitioners are faced with dual responsibilities. Clinicians are faced with the dual responsibility of the patient and ACO regulations. Patients who find the physicians more concerned with the reduction of the costs might lose trust in the patients and opt-out for the service. The patient-doctor relationship should be maintained for the benefit of standard healthcare.

Thirdly, competition might arise from the management. It’s usually accompanied by the primary healthcare and the specialists portraying unfair competition in their fields. Competition may occur between the clinicians and the hospitals, especially on the provision of the incentives by the ACO. Inpatient and outpatient clinicians competition might occur depending on the section that has more clients.

Patients are the final section where the challenges might be experienced. The freedom and the choice of the patient poses a significant challenge to the health providers. ACO is stipulated in the constitution, and most of the patients are not informed about the ACO, which brings rivalry. For example, on the provision of referrals to the patients.

Secondly, the confidentiality and privacy of the patient is another challenge. Clinicians might share critical patient data to the payers and the ACO’s. Once patients realize that their health records circulate over different people may lose trust in the facilities. Finally is patient engagement. The patient engagement by the clinicians poses a significant challenge to the healthcare sector. The ACO leaders might have ill intentions when engaging patients, and they should be approached, respectively.

Advantages of an Accountable Care Organization

ACO has improved benefits to the health of the patients and the public. First, the program provides affordable healthcare by reducing the costs of treatment. Patients get access to healthcare anytime they require it. Secondly, there is a provision of incentives to the physicians, which makes them work the extra mile in the provision of quality healthcare to the patients. Finally, ACO provides good healthcare to the public in general since everybody can access healthcare facilities.

Recommendations

Healthcare management should establish a professional mechanism to deal with the unethical behaviors posed by the clinicians. For example, clinicians should not engage in malpractices, which are contrary to the ACO’s benchmark contract for selfish gain. Leaders should monitor all the activities to ensure there is no breach of contract, especially on the payments. ACO should come up with a concrete decision-making approach to control further challenges.

ACO should work in collaboration with the clinicians to ensure there are guiding principles in safeguarding the patient’s interests. ACO should ensure that there are sound strategies to reduce the competition and foster teamwork among the physicians to deliver quality healthcare to the patients.

Conclusion

In conclusion, ACO has benefited people by providing better healthcare to the public, which is affordable to them. ACO is faced with several challenges cutting across from management, patient, and clinicians. Provided recommendations will avert the obstacles and offer longlasting solutions to the problems highlighted in the policy memo.