National Accountable Care Organization Summit.
National Accountable Care Organization Summit.
Accountable Care Organizations (ACOs): is a number of individuals that consist of health care providers and health care settings, collectively working together to accomplish the goal of improving optimum quality of health care. This network of people may include physicians, surgeons, pharmacists, doctors, nurses, healthcare assistants, caregivers, lab specialists, psychiatrists, mental health professionals, rehabilitation workers, other healthcare specialties and hospitals. This group of people collaboratively work together to coordinate patient care to obtain maximum care for clients and the group “accepts joint responsibility for health care spending and quality for a defined population of patients” (Song, 2014). According to Song (2014), the three key characteristics of the ACO are: “joint accountability,” accountability for both quality of care and health care spending, and the ACO is responsible for the care of a population of people.” In the ACO plan patients have more freedom to choose the type of care within a restricted time period. ACO provides a variety of payment structures and incentives to health care providers and hospitals primarily focusing on quality of care and financial risks to hospitals and physicians. ACO reward health care providers for the quality of care provided to patients, while eliminating irrelevant spending. ACOs do not focus on profit, but the quality of care while MCOs focus on profit.
References:
Andrews, M. (2014). What’s the best health plan for you? HMO, PPO, EPO or POS? Retrieved from https://www.washingtonpost.com/national/health-science/whats-the-best-health-plan-for-you-hmo-ppo-epo-or-pos/2014/08/25/772f96a8-27c1-11e4-958c-268a320a60ce_story.html?utm_term=.51bd23ba540e
Humana. (n.d.). HMO vs. PPO: Which one is right for you? Retrieved from https://www.humana.com/all-products/understanding-insurance/hmo-vs-ppo
Song, Z. (2014). Accountable Care Organizations in the U.S. Health Care System. J Clin Outcomes Manag. 2014 Aug 1; 21(8): 364–371.
Student 3 Talisha
An MCO is a type of health care system that links health insurance with care delivery for a defined population. An MCO delivers health care through a network of providers, determines the prices for services, coordinates care, and manages appropriate use of health care services. According to the National Accountable Care Organization Summit (n.d.), ACOs are provider collaborations that support the integration of groups of physicians, hospitals, and other providers in different ways around the opportunity to receive additional payments by achieving continually advancing patient-focused quality targets and demonstrating real reductions in overall spending growth for their defined patient population. According to Shortell, Casalino, and Fisher (2010), there are at least five different types of practice arrangements that could serve as ACOs: the integrated or organized delivery system, multispecialty group practices, physician-hospital organizations, independent practice associations, and “virtual” physician organizations. The Accountable Care Model (ACO), the health care providers develop and drive the models’ respective agendas (McWilliams et al., 2016).
Given the similarities seen between MCOs and ACOs it is clear that MCOs have a more monopoly set up on their delivery method of care; while ACOs allows for free movement outside or within their integrated networks. Centers for Medicare and Medicaid Services (2015) states that participation in ACO is voluntary. This implies that the patient consumers have the freedom to select the Primary Care Physician of their choice, the hospitals they want and their favorable specialist. Given the current healthcare environment over time MCOs and ACOs can evolve into more organized networks of practices that will actively engage in practice redesign, quality improvement initiatives, and implementation of much more innovate technologies moving forward, for example one of their noteworthy success has been the implementation of electronic health records. The Electronic Health Records (EHRs) are now giving doctors and physicians real time secure access to patients records to better assist them across both MCO and ACO networks alike, saving time, money and creating more vital time providing much needed focused patient care.
Reference
Centers for Medicare and Medicaid Services. (2015). Accountable care organizations (ACO). (n.d.). Retrieved from http://www. cms. gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index. html.
National Accountable Care Organization Summit. (n.d.). What is an ACO? Retrieved from http://www.acosummit.com/past2011/overview.html
Shortell, S. M., Casalino, L. P. & Fisher. E. S. (2010). How the Center for Medicare and Medicaid Innovation Should Test Accountable Care Organizations. Health Affairs, 29 (7), 1293-1298.
