Healthcare what is aco

Joining a larger network could enable smaller providers to quickly adapt to the technology required for value-based care while keeping their autonomy. One of the goals of the ACO is to coordinate and provide seamless care by encouraging providers to work together to share information and improve patient outcomes.

Until now, the patient has been responsible for coordinating their care. This might have involved visiting various physicians, and receiving repetitive, expensive, or conflicting, medications and treatments since one provider might be unaware of what the other provider is prescribing. Each was only aware of their part of the treatment and not realizing how everything might work together which can result in fragmented care.

The focus on the patient as a whole and streamlining care can provide potential patient benefits and improve outcomes by:. Despite how an ACO is graded on providing quality care, an article by Kaiser Health News reported that some health care economists feared that an ACO would try to save money by cutting corners on patient care.

Others worried about hospital mergers and that the additional expense to meet requirements would prompt independent practices to become employed by the hospital, which could limit patient choice and potentially increase healthcare prices.

Although the prevalence of EHR adoption by independent practices has enabled easy tracking and reporting of the required data. Some have accused an ACO of being a medical insurance group that provides health services for a fixed annual fee, otherwise known as a health maintenance organization HMO. The way an HMO controlled patient options was not received favorably in the s.

Although these similarities were noted since the goal of the ACO is to replicate the cost-controlling measures of the HMO, efforts were made to eliminate the issues that made HMOs unfavorable. The pressure to now take on more financial risk is more than many ACOs are prepared to accept. Especially with inadequate information and uncertainty how patient demographics are chosen to enable organizations to be successful in meeting their goals.

No matter how the healthcare system evolves and changes in the future, most likely goals of increasing quality, decreasing cost and incorporating technology will remain. Providers will need to keep abreast of the developments in technology and required regulations. Since the inception of ACOs, they have expanded to serve patients in private or commercial payer settings in addition to Medicare and Medicaid patients.

Accountable care organizations are important because they work to improve care quality and reduce healthcare costs. Providers within an accountable care organization are required to meet specific benchmarks and are rewarded when they are able to maintain high care quality and low care costs.

When an ACO succeeds in keeping their patients healthy and spending healthcare dollars more wisely, the organization will share in the savings that it earns for the Medicare program. Providers who are part of an ACO are required to alert their patients, who can choose to go to another doctor if they are uncomfortable participating. The patient can decline to have his data shared within the ACO. ACOs can include hospitals, specialists, post-acute providers and even private companies like Walgreens.

The only must-have element is primary care physicians, who serve as the linchpin of the program. Some regions of the country, including parts of California, already had large multi-specialty physician groups that became ACOs on their own by networking with neighboring hospitals. In other regions, large hospital systems are scrambling to buy up physician practices with the goal of becoming ACOs that directly employ the majority of their providers.

Because hospitals usually have access to capital, they may have an easier time than doctors in financing the initial investment, for instance to create the electronic record system necessary to track patients.

Some of the largest health insurers in the country, including Humana, UnitedHealth and Aetna, have formed their own ACOs for the private market. Insurers say they are essential to the success of an ACO because they track and collect the data on patients that allow systems to evaluate patient care and report on the results. ACOs may sound a lot like health maintenance organizations. But there are some critical differences — notably, an ACO patient is not required to stay in the network.

In addition, unlike HMOs, the ACOs must meet a long list of quality measures to ensure they are not saving money by stinting on necessary care.

Many health care economists fear that the race to form ACOs could have a significant downside: hospital mergers and provider consolidation.

As hospitals position themselves to become integrated systems, many are joining forces and purchasing physician practices, leaving fewer independent hospitals and doctors.

Greater market share gives these health systems more leverage in negotiations with insurers, which can drive up health costs and limit patient choice. ACOs are already becoming pervasive, but they may be just an interim step on the way to a more efficient American health care system. One of the key challenges for hospitals and physicians is that the incentives in ACOs are to reduce hospital stays, emergency room visits and expensive specialist and testing services — all the ways that hospitals and physicians make money in the fee-for-service system, explains Roades.

He says the ultimate goal would be for providers to take on full financial responsibility for caring for a population of patients for a fixed payment, but that will require a transition beyond ACOs. By Jenny Gold September 14, You must credit us as the original publisher, with a hyperlink to our khn.