The term Accountable Care Organization (ACO) was first coined in 2008 by Elliott Fisher, MD, Director of the Center for Health Policy Research at the Dartmouth Medical School (Houghom & Burton, 2014). It is a model that is aimed at changing the manner in which healthcare services are delivered in order to decrease overall costs and improve the quality of services. It is a group of healthcare providers, including physicians, hospitals, nursing homes, health plans, and other key stakeholders that come together to provide a coordinated approach in the delivery of care. Unlike the current model, in which healthcare providers generally act independently and in a siloed manner, this approach strives to improve communication and coordination …show more content…
Medicare became a prime target with baby boomers entering retirement age, and the cost of caring for elderly and disabled American expected to soar (Gold, 2015). The health law created two payment models to incentivize providers:;;; the Medicare Shared Savings Program and the Pioneer Program. In the Medicare Shared Savings Program, 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 (Gold, 2015). Therefore, the providers may choose to enter at no risk for a smaller payment incentive, or at a higher risk for a larger payment incentive. The Pioneer Program is available for health systems that wish to take on greater financial risks in exchange for the opportunity to obtain even greater incentive payments. As a result, many of these are moving into a capitated payment model where they are paid a single annual payment to manage the entire risk of a patient population. In this scenario, if they are able to care for the patient at a cost less than the annual payment, they make a profit, but if the cost is greater than the annual payment, they end up in a financial loss
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
Lischko A. (2011). Physician payment reform: A review and update of the models. Massachusetts medical society.
Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
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,
The current focus on new healthcare models is a reaction to long-standing concerns around quality, cost, and efficiency. Accountable Care Organizations model focus on integrated healthcare to promote accountability and improve outcomes for the health of a defined population. The goal of integrated healthcare is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors (CMS, 2014). The following paper will analyze an ACO’s ability to change healthcare in the United States.
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.
For patients, when ACOs are fully functional they represent an increase in patient experience in several ways. First ACOs allow open communication between physicians from different specialties coordinating together to determine solutions. Second, ACOs also establish a single point of contact for all questions concerning care. Finally, these organizations represent a centralized network of physicians for the patient, creating a team to deliver comprehensive care. In fact, there is mounting evidence that suggests the potential benefits of care coordination in ACOs for both patient experience and quality, including reduced hospital admissions, improved quality of chronic disease management, improved patient satisfaction, and better access to specialty care (Stille, 2005). For providers, ACOs provide an opportunity for better collaboration on the various modalities they use on their patients, as well as improved workflow and communication. There are several stakeholders in which the large scale implementation of ACOs would affect. Federal and state government health insurance programs like Medicaid and Medicare, one type of stakeholders. With the implementation of ACOs and the shared savings model, Medicaid and Medicare now have a financial incentive to partner with healthcare organizations to deliver better outcomes at lower costs. If done correctly, Medicaid and Medicare stand to save large
The United States health care system ranks 37th in the world. Statistically, it’s bizarre how United States is amongst one of the most advanced nations in the world and the fact that it spends more on its healthcare than any other country, yet its standards are incomparable to other European nations. Unlike most countries, America doesn’t have universal coverage for health care. This means that it is the responsibility of an average American to obtain health insurance either through private insurance companies or through their employer. Under this system, there is a notion of a certain premium due at regular intervals of time but the insured may need to “co-pay” or pay a certain deductible for their treatment before their insurance takes care of the rest.
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 two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
In the words of Brené Brown, “Our identities are always changing and growing, they’re not meant to be pinned down.” These insightful words came after history’s most tragic event: the Holocaust. It was a time in which ideas, beliefs, and humanization were “pinned down”, furthermore, identities were stripped from their owners, resulting in a multitude of Jews being branded as nothing more than bodies. Elie Weisel’s novel, Night, explains his identity loss from extermination to liberation. The question is, what is your identity?
Fee-For-Service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when patients are shielded from paying cost sharing by health insurance coverage, they are incentivized to welcome any medical service that might do some good. FFS is the dominant physician payment method in the United States, it raises costs, discourages the efficiencies of integrated care, and a variety of reform efforts have been attempted, recommended, or initiated to reduce its influence.
The improvement of health, enforcing policies, and monitoring comes from interrelationships between governmental and non-governmental entities. Since the 21st century the apparent need for an improved public health infrastructure has been a recurring topic on the state, local, and national level. In 2010 the Affordable Care Act authorized numerous clinical health reforms, a big step towards providers being accountable. {ACOs} Accountable care organizations are conducting health assessments and reporting metrics to payers. According to Magnuson and Fu, Jr., “Public health agencies must, in turn, evolve from being the only entities capable of assessing and monitoring population health to strategic and enabling partners involved in population health practice” (2014). A sense of involvement and shared work load is needed to help shift the challenges public health officials face. Public health officials promote and protect the community. With the involvement of other organizations more polices can be enforced and created to improve population