Accountable Care Organizations (ACO)

Healthcare in the United States (U.S.) continues to change and evolve due to multiple environmental forces such as changes in legislation and payment models, aging population, increased prevalence of chronic diseases, advances in technology, and pressures to lower the cost (Martin, 2013). Nursing has always been at the heart of healthcare, however, there is an impending shortage that has been projected by 2025 (Martin, 2013). We are moving from a volume-based to a value-based payment system through the MACRA legislation where providers will be reimbursed not necessarily by how many tests that are performed, but how well they care for a population of individuals based on quality measures and cost (“FAQ on MACRA,” 2016). Nurses are taking on

These steps include: increasing urgency, building a guide team, creating the right vision, communication, empowering others to act, creation of short-term wins, not letting up, and making the changes stick (Kotter, 2002). In healthcare currently the change in the payment model is what is driving the change in delivery of patient care and thus it has created a sense of urgency throughout my organization as well as the nation. Accountable Care Organizations (ACO) have emerged and are serving as the guiding team to help multiple healthcare organizations work together to improve the quality of care that is delivered. The ACO, serves as the guiding team and is responsible for setting the vision and the strategies that will be utilized for the change effort. Monthly meetings, email, and other means of communication is utilized to ensure that all members of the ACO receive up-to-date information on changes in payments, that encourages others to buy into the changes. Throughout the various organizations, a culture of empowerment is used to encourage employees to act on the vision of the ACO. Multiple short-term goals have been set, once a goal is reached a new goal is announced that helps to further the ACO’s

Since joining the ACO, my current position has been created, RN Population Health Coach. This role is focused on managing the population that is within the hospital and clinics area of service. Focusing on patient engagement, preventative care and screenings, alongside the frequent use of process improvement cycles. While this is a very exciting time, it is also very stressful. As there is not a set of guidelines that will help implementing patient-centered care in a rural community hospital successful, we have had many barriers to overcome. Some of these barriers have simple solutions, others we have had to adjust to and work around in a different manner; this is still a work in progress. This is a very unstable time in healthcare, particularly true to small, rural areas. For my organization to succeed we must handle the challenges well, otherwise it will end up costing the company in both revenue and employee retention (Kotter, 2002). According to Lewthwaite (2000), change is a major source of stress; while a certain level of stress can help to improve performance, too much can have a negative impact on performance. It is imperative that our organization assess and continue assessing for signs of negative stress effects on the employees, as we continue down our road to changing healthcare for rural communities in central