Impact of Accountable Care Organization in Healthcare Provision

Impact of Accountable Care Organization in Healthcare Provision

Accountable Care Organizations

The Accountable Care Organization was introduced as a new payment model through the Affordable Care Act for Medicare patients in 2010. The Accountable Care Organization is characterized by a system of healthcare providers, including the hospitals, physicians, and specialists (Fisher & Shortell, 2010). They voluntarily provide high-quality, coordinated care and share medical and financial responsibility to minimize unnecessary expenditure. The Accountable Care Organization healthcare model focus on giving incentives to healthcare providers that meet specific requirements on care quality, cost measures, accountability, and several other provisions. The Accountable Care Organization incentives include bonuses for minimizing the cost of healthcare expenses or penalty waivers due to increased costs (Fisher & Shortell, 2010). The main objective of the healthcare providers involved in Accountable Care Organization programs is to emphasize on the management of patients suffering from chronic diseases, maintaining good health, and disease prevention. This paper discusses the impacts, challenges, and roles of the Accountable Care Organization as a healthcare provider.

Impact of Accountable Care Organization as a Healthcare Provider

ACOs can transform ho care is manifested and paid for so that the patients can receive substantial quality care, patient-centred, with a well-coordinated and timely. Patients primarily in an ACO, they are given attention from hospitals and physicians that are rewarded for offering the quality care at the right time, and place (Fisher & Shortell, 2010). The rewarding of care providers is based on high proficiency services they offer to the patients and not on the quantity or the number of test and procedures they provide. As such, the Accountable Care Organization has produced substantial consequences as a health provider in the health system.

Improved care coordination has significantly been realized. Unlike previous where patients received health care in silos, where coordination and communication lacked between patients and doctor, the aspects have been changed through the formulation of ACOs. The organizations have played a pivotal role in fixing such fragments by improving coordinated and communication among the health providers and between patients Kaufman et al., (2017). The aspect is done by bringing together different components of health systems, such as primary care, specialists, and hospitals to ensure all segments work altogether.  The other impact of ACOs is it has maximized the use of HIT. Through effective coordination and communication, ACOs have used HIT gadgets to track patient’s medical information such as EHR Kaufman et al., (2017). Such information is critical in avoiding unnecessary or duplicative test and procedure. The other significant impact associated with ACOs is that patient and family engagement has been grounded. The family and patients involvement it has been discovered to produce positive health outcome.

Accountability Care Organizations

There is no clear definition of the word; ultimately the term is primarily used to describe a collective group of hospitals, physicians, and other health care providers who collaborate as an entity with a primary aim of improving the quality care for the patients McWilliams et al., (2014). ACOs are grounded in all shapes and sizes where small provider entities formulate some, and others are extensively formed to deliver integrated services to patients.

The primary aim of establishing the entity is to ensure that high quality coordinated care, which is delivered across the health care delivery system that ranges from primary care, hospital stays to post-hospital rehabilitation. For the ACOs to be effective in overseeing the coordinated care across health care services and settings, they concentrate on three main objectives (Fisher & Shortell, 2010). On improving the population’s health, the patients and family care experience as well as reducing the cost of care. In ACOs, rules and regulations differ across on its three types, the Medicare, Medicaid, and commercial insurance markets.

In ACOs, two core issues are charged with dealing with duplication of services and high billing. According to CMS, elaborates the goals of coordinated care is to facilitate patients, especially the chronically ill receive care at the right time while circumventing needless duplication of services and thwarting medical faults.

Challenges

Accountable Care Organization has been faced with several problems that have compromised the effectiveness of ensuring the patients receive best and quality care.  The challenges such as lack of adequate lives to take risks Barnes et al., (2014). The obstacle of scale where the majority of Medicare simply are too small to counteract the issue of statistical variation. For example, an ACO that has less than 100, 000 lives cannot portray Medicare sharing savings. The other conventional challenge faced by ACOs is the lack of accountability and transparency that compromises training and process improvement. An effective ACO needs to ground clear visibility into and influence actions that health providers can control to foster collaboration and attain stipulated mission and vision Barnes et al., (2014). As a result, failure of accountability and transparency, training and process improvement have been hindered, the aspect that makes the front office to clinicians to senior executives, and all members of organizations loose sense in understanding their specific roles.

Additionally, the practices lack staff supporting population health. Support staff plays an important role, especially the population health nurses to the success of ACO. They primarily offer preventive care, manage chronic care, among other planned care and behavioral health integration. The lack of support hinders the delivery of such critical services that are essential to ACOs success. More so, it is difficult for clinicians to access data at the point of care that pertains patient’s medical information Barnes et al., (2014). Most of the ACOs entities concentrate on enterprise-wide analytics that is rarely important due to statistical variation. Also, the challenge of doctors not being on board, and incapability to execute on quality improvement and to report compromises the workability and accountability of ACO.

Healthcare Role Changing

The challenges encountered in ACO can significantly influence the role of a health worker by making patients not to receive quality care. The issue of scale that has fewer lives can make the organization not to be sustainable and disintegration of the parties involved in delivering quality healthcare. Resources are critical in ensuring the ACO are successful alongside features of transparency and accountability. These aspects if are not grounded appropriately the stipulated aim of healthcare role to change.

Failure to offer the required tools such as relevant data to provide treatment, and other related medical information brings no sense as a healthcare worker in giving quality care. These challenges they overturn the primary aims offered by ACOs, making them fail in playing a critical role intended in the health care system. The aspects can demoralize many physicians, hospitals, and other healthcare providers to shift from the profession if they realize they can’t help patients to recover from their issues.

Conclusion

In summation, the Accountable Care Organization has frolicked a pivotal role in ensuring better health care for Medicare patients. The aspects have helped in saving money for both providers and patients and control any waste in the healthcare system. The high-quality, coordinated care to patients that have is provided by collaborative groups of physicians, hospitals, and other healthcare providers have significantly helped patients to receive very best across the United States health system

However, ACOs have faced several challenges that have made them fail. Some of the challenges include, inadequate resources that hinder training and process improvement, lack of accountability and transparency, inaccessibility of patient’s medical information hinders the success of quality care delivery. Therefore, it is critical to formulated grounds that are important to handle the challenges for sustainable quality care delivery. These problems faced if effectively tackled, the features of persuasion realized with ACOs can be maintained and further improved. As such, can produce more positive impacts apart from improving coordinated care, maximization use of HIT, and patient and family engagement

References

Barnes, A. J., Unruh, L., Chukmaitov, A., & Van Ginneken, E. (2014). Accountable care organizations in the USA: Types, developments and challenges. Health Policy, 118(1), 1-7. doi:10.1016/j.healthpol.2014.07.019

Fisher, E. S., & Shortell, S. M. (2010). Accountable Care Organizations. JAMA, 304(15), 1715. doi:10.1001/jama.2010.1513

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2017). Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review. Medical Care Research and Review, 76(3), 255-290. doi:10.1177/1077558717745916

McWilliams, J. M., Landon, B. E., Chernew, M. E., & Zaslavsky, A. M. (2014). Changes in Patients’ Experiences in Medicare Accountable Care Organizations. New England Journal of Medicine, 371(18), 1715-1724. doi:10.1056/nejmsa1406552