HCA 675 What are your thoughts about the emerging accountable care organizations?

The new accountable care organizations or ACOs as they are commonly called came about as the health system in the U.S began to restructure and redesign (Babyar, 2016). Under the Affordable Care Act (ACA) there were proposed as new policies to facilitate better coordination of care between health care providers and health systems (Babyar, 2016). Especially for those who are insured through Medicare provisions (Babyar, 2016). ACOs require that there be voluntary participation from the health systems and providers to help improve the quality of care and the lower the healthcare costs (Babyar, 2016).

With my work in health insurance, I get to work alongside the ACOs who manage some of our networks and members. They are extremely helpful in managing the care, cost, and networks of those under their care. I know that the insurance company I work for has also seen a great reduction in cost since implementing the ACOs. They were created based upon the “promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume” (Fullerton, Henke, Crable, Hohlbauch & Cummings, 2016, p.1257). One of the areas that they are key in managing the care and services for members are those that have mental health issues (Fullerton et al., 2016). For years there has always been notoriety in mental health that the patients tend to not be compliant, and facilities are overwhelmed and lack available beds for treatment. ACOs have been key in helping to streamline the coordination of treatment for these people with mental health issues (Fullerton et al., 2016). I get to see it with my own eyes at work as they work to coordinate available treatments, providers, facilities, and network exceptions in order to promote uninterrupted care for these members. Most of my work with them has been for out of network exceptions related to members who are experiencing access to care issues. Having the support of the ACOs has been integral in finding providers and services and negotiating with them in order to provide the most benefit to our members.

ACOs are already affecting the current health care delivery system because of their coordinating and collaborating efforts, they have improved the ease for people to find providers and services. The practice patterns of primary care physicians will be more focused on quality care measures, and less cost. Another great way they are making an impact is that the ACOs are now presenting new opportunities to address the gaps in healthcare often experienced by those in rural areas of our country (Ortiz, Bushy, Zhou & Zhang, 2013). These populations are most notably at risk of having suboptimal care because of their location and the scarcity of providers associated with their remote location. Many do not even have established primary care providers so often underlying health issues are never treated and result in more serious consequences down the road. Thus, with ACOs working alongside organizations such as the Rural Health Clinic management or RHC puts the focus back on patients getting set up with steady primary care providers who can focus on the patients and improve their health outcomes (Ortiz et al., 2013).

HCA 675 What are your thoughts about the emerging accountable care organizations

Lastly, as with any system, it is impossible to have it be perfect and not exert any ill effects. One of the negatives of ACOs specific to their effects on primary care practices is that they exclude some physicians. This happens because the very nature of the ACOs can make it extremely difficult for “small, independent, physicians to get involved, and that drives independent physicians’ wariness of ACOs” (Becker’s Hospital Review,2013, para.1). There is a perpetuating belief that with independent physicians versus their counterparts working for larger health systems switching to an ACO will not truly improve the quality of their care (BHR, 2013). Rather they feel that is more likely that joining an ACO will have a negative impact on their small practice particularly in the aspect of their profitability (BHR, 2013). Mainly because of the fact that participating with an ACO will require more time and effort for the physicians to spend on “reporting metrics and filling out more paperwork—putting a damper on the time-independent physicians spend seeing patients” (BHR, 2013, para.2). A burden that they cannot financially bear and thus it hinders their desire to participate openly with an ACO (BHR, 2013).

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Becker’s Hospital Review. (2013). 2 of the largest problems with ACOs. Retrieved from https://www.beckershospitalreview.com/accountable-care-organizations/2-of-the-largest-problems-with-acos.html

Ortiz, J., Bushy, A., Zhou, Y., & Zhang, H. (2013). Accountable Care Organizations: Benefits and barriers as perceived by Rural Health Clinic management. Rural and Remote Health, 13(2), 2417-2436. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761377/

Fullerton, C., Henke, R., Crable, E., Hohlbauch, A., & Cummings, N. (2016). The impact of Medicare ACOs on improving integration and coordination of physical and behavioral health care. Health Affairs, 35(7), 1257-1265. Retrieved from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2016.0019

Babyar, J. (2016). Opportunities and Accountable Care Organizations. Journal of Medical Systems, 40(11), 248–250. Retrieved from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118700353&site=ehost-live&scope=site

Response

Felice, this is a great work. You have delved deep into the topic by providing insightful details about ACO including the potential benefits in improving the healthcare provision and service and the potential limitations. Indeed, it undoubted that you had a great grasp of the topic. In concurrence, ACO have changed the traditional healthcare models by aligning various elements of patient care such as primary care, home healthcare providers, facilities, and specialists into an organized collaborative care by ensuring effective communication and coordination of patient care (Lewis, McClurg, Smith, Fisher & Bynum, 2013). Besides, ACOs are vital in ensuring quality of care to patient by stressing that their network should meet performance standards set by CMS. They also strive to eradicate needless to reduce the overall cost of care.

References

Lewis, V. A., McClurg, A. B., Smith, J., Fisher, E. S., & Bynum, J. P. (2013). Attributing patients to accountable care organizations: performance year approach aligns stakeholders’ interests. Health affairs, 32(3), 587-595.

Re: Topic 8 DQ 2

Accountable Care Organizations (ACOs) comprise of voluntary coordination of health care providers to control costs and increase quality for Medicare patients (Centers for Medicare and Medicaid Services, 2020). I think coordinating care between the primary care provider (PCP), specialist, hospital, and any other stakeholder in the patient’s health is valuable to both outcomes of health and the expense of health care delivery. This coordination encourages collaboration of care and decreases expenses by reducing duplicate health services and errors and promoting the right care at the right time (CMS, 2020). These efforts may affect the current health care delivery system by promoting accountability among providers through reimbursement. When quality performance standards are met by providers, then the financial reward is greater compared to those that have poor health outcomes following treatment (Babyar, 2016).

This new model of health care will impact the practice patterns of PCPs as those with a significant number of Medicare patients will want to understand and achieve criteria that dictates reimbursement. This voluntary participation will include management of four quality care measures including patient and caregiver experience, preventative health measurements, care coordination and patient safety, and identifying at-risk populations (Babyar, 2016). ACOs also present several significant problems for primary care practices. Some of those problems include that it does not account for the behavioral health population, vulnerable and disadvantaged populations, and it lacks medical direction and leadership (Babyar, 2016). These issues are important to research and address for this model going forward. Babyar (2016) explains that Medicaid populations were in mind when creating ACOs but there are still populations that have historical payment structures in place in which ACOs do not improve upon. Overall it appears that ACOs represent progress in controlling costs and increasing quality in health care services, yet still present opportunities for certain populations. If government-controlled health care increases in the future, the participation of providers in these types of models will likely be mandated or necessitated to remain competitive in the industry. Thoughts?

References

Babyar, J. (2016). Opportunities and Accountable Care Organizations. Journal of Medical Systems, 40(11), 248–250. https://doi-org.lopes.idm.oclc.org/10.1007/s10916-016-0625-z

Centers for Medicare & Medicaid Services. (2020). Accountable care organizations (ACOs): general information. Retrieved from https://innovation.cms.gov/innovation-models/aco

Response

Amber, this is a concise perspective about the ACOs and it shows that you clearly understood the topic. However, despite the optimism about the potential benefits of ACOs such cost reduction and enhancement of quality of care, it is worth noting that ACOs are associated with some limitations. First realization of the cost reduction has been slow and below the original expectations. Besides, many providers are reluctant to adopt the new paradigm of payment. Some also claim that there are fundamental changes in the healthcare delivery system and that the efforts to encourage ACOs have been mostly underwhelming (Hodges, 2015). However, despite the criticism, there should be no attempt to turn back to the unsustainable old system, which is characterized by payment for procedures instead of value.

References

Hodges, N. (2015). Accountable Care Organizations: Realigning the Incentive Problems in the US Health Care System. U. Fla. JL & Pub. Pol’y, 26, 99.

HCA 675 What are your thoughts about the emerging accountable care organizations?