Practitioner
Article: Accountable Care – Journey begins by Keith D Moore and Dean C
Coddington
Purpose of the Article
The formation
of Accountable Care Organizations (ACOs) is gaining popularity with the
enactment of Patient Protection and Affordable Care Act of 2010. The term Accountable
Care Organizations was coined by Elliot S. Fischer, Director of the Center of
Health Policy Research at Dartmouth Medical School (Cohen 2010). Accountable
care organizations have its benefits as well as its risks. Strategies to
overcome those risks are effectively devised to make ACOs as effective as
possible.
Basic Findings
The Centers for Medicare and Medicaid Services (CMS) defined Accountable
Care Organizations as “legal entities that accept payments for a defined
population of patients and distribute those payments to providers” (Schlossberg
2010). The two other characteristics are “relying on an information technology
platform with systems to promote evidence based medicine” and “the capability
to analyze clinical data based on quality and cost data” (Schlossburg 2010).
Managerial Implications/Role to reduce risks in an ACO
If information
about payments is unavailable in a timely manner, facilities may be declined
payments or may face delays. So, timely information receipt is the key for functioning
of an ACO. With the receipt of timely information, payments to ACOs can be punctual.
Two major risks in ACO payments are actuarial risks and performance risks that
healthcare facilities are making attempts to curb. By effective assignment of
risk to designated personnel ACOs are more effective by addressing the risks. When
a proposal is first made to clinically integrate organizations or create
accountable care organizations, the proposal tends to be scrutinized.
Therefore, approval is not effective immediately and hence results in delayed commencement
of the project. This gives inertia from the time of submission for approval to
actual approval phase. Clinically
integrated organizations are believed to be lead to ACOs at the next stage. But,
to have most of the organizations clinically integrated is taking longer than
expected. This lag results in delayed start up costs. For optimal operations,
it is advisable to have the correct mix of physicians participating in ACOs. The
presence of correct number/mix of qualified personnel can help process
operations more effectively and efficiently without hindrances.
To summarize, timely information receipt, effective risk assignment
between personnel, lag from the time of submission to approval, delayed startup
costs, and having a correct mix of ACO participating providers are measures
managers can take to reduce risks in an ACO.
References:
The emerging concept of Accountable Care Organizations (ACO’s) is no doubt developing after the mandatory law, but as mentioned in the article, the progress of the ACO’s is slow because of startup costs and lack of organizational set up. I think with the passage of time, the development of ACO's will reform the health care industry, and will re-design the industry to provide not only high quality but also cost efficient care to all the patients.
ReplyDeleteI really enjoyed this blog. One of the main technological improvements to increase clinical integration is by implementing electronic medical records. They increase the speed of communication while providing easy access to historical patient data. With the passage of the PPACA, we will see an increase in ACOs as mentioned. And, one of the keys to a successful ACO is IT infrastructure. Having an efficient IT system will allow providers to acquire better quality measures. Quality of care and value given to the patients will therefore increase with the increase in ACOs. However, there are legal barriers such as antitrust laws governed by the Federal Trade Commission and the Stark law that might cause start-up costs to be extremely high and hard to overcome. For example, the benefits of an organization moving towards an ACO (such as through a granfathered-in program as described in the PPACA) might not create enough value for the organization to make the transistion via large expenditures.
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