Are Accountable Care Organizations beneficial to the healthcare system? Accountable Care Organizations (ACOs) are groups of health care providers, doctors, and hospitals who work collectively and freely to provide organized excellent quality care to the patients. The aim of this arrangement of care is to make sure that the patients, get the right care at the right time, avoiding pointless repetition of the services and avoiding medical slip ups. If it does well both in providing high-quality care and disbursing health care dollars, it would be able to share the savings it attains for the Medicare program. Accountable Care Organizations (ACOs) programs offered by Medicare • Shared Savings Program: It is dedicated to achieving better health for …show more content…
The ones operating within the Medicare Shared Savings Program that do not qualify quality performance standards within a program may not be eligible for sharing the savings. Although there may be some challenges in the operation of accountable care organizations (ACOs), payers and healthcare providers are not permitting that stand in their path as they continue investing in new alternative payment arrangements and rather than the traditional fee-for-service reimbursement model. A transformation in the health care will help decrease waste, improve quality, member/patient satisfaction, and complete employee health and productivity. If an affordable care organization (ACO) adopts risk-based payment contracts it is likely to achieve success in its endeavors as it brings accountability and monetary motivation for physicians to change their best practices and improve quality to reduce healthcare spending. In other words they may garner cost savings and decrease the spending through reducing emergency room visits and hospital admissions. There is a considerable reduction in the costs of care. It can help in making healthcare
Cimasi, R. J. (2013). Accountable care organizations: Value metrics and capital formation. (pp. 90-92). CRC Press. Retrieved from http://books.google.com/books?id=EDMTlDWYvmUC&dq=specific service payment bundled&source=gbs_navlinks_s
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
The Affordable Care Act seeks to reduce health care costs by encouraging doctors, hospitals and other health care providers to form networks which coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Accountable Care Organizations (ACOs) make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 provider groups have already signed up (CMS, 2014). An estimated 14 percent of the U.S. population is now being served by an ACO (CMS, 2014).
Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.
Perspective Stakeholders in health and social care can be referred to a person, group or organization that has interest or concern in an organization. Stakeholders can affect or be affected by the organizations actions, objectives, and policies. Some examples of key stakeholders in health and social care are inspecting bodies, managers, employers, government and its agencies, owners of care services, owners of local businesses, suppliers, trade unions, service users, and the community which the organization serves. For example, a local health and well-being strategy may be developed by;
Emory Healthcare. (2017). Retrieved September 16, 2017, from https://www.emoryhealthcare.org/about/care-transformation/index.html Care Transformational Model Donadio, G. (2005). Improving Healthcare Delivery with the Transformational Whole Person Care Model. Holistic Nursing Practice, 19(2), 74-77. Sollecito, W.A. and Johnson, J.K. (2013). McLaughlin and Kaluzny's Continuous Quality Improvement in Health Care. 4th Edition. Sudburry, MA: Jones and Bartlett Publishers. (Healthcare,
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
The United States (U.S.) has a health care system that is much different than any other health care system in the world (Nies & McEwen, 2015). It is frequently recognized as one with most recent technological inventions, but at the same time is often criticized for being overly expensive (Nies & McEwen, 2015). In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) (U. S. Department of Health & Human Services, n.d.) This plan was implemented in an attempt to make preventative care more affordable and accessible for all uninsured Americans (U.S. Department of Health & Human Services, n.d.). Under the law, the new Patient’s Bill of Rights gives consumers the power to be in charge of their health care choices. (U.S. Department of Health & Human Services, n.d.).
The NHS change model has been selected for this quality improvement. The NHS change model consists of eight dimensions, which are described as a useful tool to enhance change. This model has been identified as being effective in health care organisations, encouraging the use of teamwork to implement systematic improvements.
The passage of the Affordable Care Act (ACA) in March 2010 represented a significant turning point in the evolution of health care in the United States and presents boundless opportunities for APRNs (The Patient Protection and Affordable). The ACA promises to add 32 million Americans to the rolls of the insured amidst a shortage of primary...
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
In 2015, the Centers for Medicaid and Medicare Services (CMS) released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which implements the final rule which offers financial incentives for Medicare clinicians to deliver high-quality patient centered care.5 Essentially, taking the time to learn the patient’s goals and treatment preferences allows for the patient to walk away from the medical treatment or service feeling understood and cared for by the provider.4 Thus, resulting in a better, more comprehensive plan of care. Policy makers are hopeful that the new incentive-based payment system will accelerate improvement efforts.
...mplications that allow for opportunities of change. One of the presumptions is for training and staffing (Shi & Singh, 2012). With the utilization of health care improvements, the staff will need additional instructions on the performance of equipment and how to efficiently achieve the desired results. Managers or supervisors recognize the need for supplemental staffing and training to optimize patient satisfaction and quality of care. The health care administrator must also focus on changes in insurance policies and rules governing the provision of medical assistance (Shi & Singh, 2012).
...ue to numerous medical errors. With the amount of medical errors that currently do occur which is a current health care issue it cost the health care billions of dollar each year to fix the mistakes that were made.
Health care has always been an interesting topic all over the world. Voltaire once said, “The art of medicine consists of amusing the patient while nature cures the disease.” It may seem like health care that nothing gets accomplished in different health care systems, but ultimately many trying to cures diseases and improve health care systems.