By Arketa Vazquez
According to the Center for Medicare and Medicaid a Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers (this includes private health insurance companies), who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care 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.
According to the Center for Medicare and Medicaid a Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers (this includes private health insurance companies), who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care 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.
When an ACO succeeds both in
delivering high-quality care and spending health care dollars more wisely, it
will share in the savings it achieves for the Medicare program.
The main focus of the shared savings program was to increase value of care by providing better care for individuals, better health for population and lowering growth in expenditures.
ACO’s exist in the 50
states. With California having the most with 81 ACOs.
Many private insurance
companies are looking to get involved with Shared Savings programs/ACOs to
lower the cost of health care, as well a improve member experience and provide
quality care. According to the Kaiser Health News, many larger private ACOs, insurers
can also play a role, though they aren’t in charge of medical care. Insurance
companies feel they are essential to the success of an ACO because they track
and collect data on patients that allow systems to evaluate patient care and
report on the results.
If insurance companies, physicians, and hospitals are
involved with ACOs and Shared Saving program, can these programs truly lower
the cost of health care, while truly providing quality of care to their
patients or will patient care suffer at the hands of trying to lowering cost of
healthcare in this the United States?
The Medicare Shared Savings Program could have a positive impact on healthcare by delivering coordinated care in which income is based on improved health outcomes, not number of services. But without standards and quality controls, all of these efforts could be ineffective. ACOs have operated in a way to avoid enrolling patients whose care is seen as costly (cherry picking) and provide less care than the intended beneficiaries require (rationing). Sadly the model has collapsed as sicker patients have found their way in. It's a reminder of the HMO disaster. ACOs are unfortunately accountable to the Centers for Medicare and Medicaid services... and in the end, hospitals can't keep patients out of beds and still make money. So really, until the dollars and cents are on the right side of the equals sign in the equation, then no, I don't think these programs will work beyond a few years.
ReplyDeleteIn its purest form I think that ACO's could in fact help improve outcomes for patients and lower the cost of healthcare. Our current model is extremely fragmented, patients will often have several different doctors, in several different practices each managing one specific issue (i.e. cardiologist, nephrologist, rheumatologist, etc). Since these physicians do not practice together the patient ends up being managed piece (or organ) by organ. Aside from (SOMETIMES) receiving a copy of the office visit note from another physician caring for a particular patient, doctors are often unaware of any new details that arise in a patients condition outside of the sub specialty that they are caring for. So who does the onus fall on? The patient. More often than not a patient is not a health care professional and attempting to procure the appropriate reports and knowing which of their health care providers actually need the information can be daunting.
ReplyDeleteI think that this is a large reason why up to now Medicare and Medicaid and health insurance companies have been such an import source of data- they are the only ones who get the complete picture of what is going on with a patient (or at least can piece it together through the testing, treatment and appointments a patient is having). It is interesting and extremely fitting that you mention Kaiser in your post. Kaiser has a model not dissimilar to the single payer model- it is both insurance company and healthcare provider. This model has allowed Kaiser to build a comprehensive and powerful electronic medical record and database for its patients. The former allows all healthcare providers involved in a patients care to see all of their health information in a one consolidated location, allowing them to see the bigger picture of the complete individual, not only one small portion. This leads to higher quality of care, creating a team of healthcare providers working to help the patient instead of individuals working in parallels. The later enables Kaiser to track outcomes for specific patient cohorts and account for abundantly more variables, since multidisciplinary data is housed in the same platform. This is a tremendous value add especially when looking at cohorts of patients with multiple comorbidities. This type of data helps to move medicine forward as it allows us to look at large groups of patients to help determine risk and prognostic factors as well as outcomes.
This really seems to be the idealistic goal of ACO's, it would allow patient data to easily be shared amongst their healthcare providers in order to provide more comprehensive healthcare for the patient, which in turn would lead to less hospital stays, unnecessary testing and overall lowering of healthcare expenses. Unfortunately political agendas and profit driven decisions will likely not allow these programs to realize their goals.