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Accountable Care Organizations and what they need to do to be successful

Accountable Care Organizations (ACO) refers healthcare stakeholders who voluntarily come together to give a well-coordinated quality care to patients who are under Medicare. The arrangement is such that providers work closely to achieve a common goal of better health care delivery at a lower cost (Kuramoto, 2014). Moreover, it also allows patients to choose and form a partnership with health care providers that they think meets one’s personal needs. Today, ACO has provided greater opportunities by providing an improved analytical tool that can effectively support improved health information technology.

The success of any ACO model is the encouraging of clinical excellence and improvement, while doing cost control, post-acute care facilities, offering incentives to medical specialists and facilities and other providers that work with these services (Stenson, 2013).  The improvements that other new care and ACO models hope to accomplish will demand a clear sense of what optimal care is all about from the patient’s point of view. This aspiration will require implementation by patients and professional across the broad spectrum of care in the shared vision of patient’s and other important factors. ACO is dependent on the reporting performance and health information structure and patient’s knowledge to numerous audiences both internal and external (Lieberman, & Bertko, 2011). Internally, care provider organizations in ACOs will desire to perform on a number of quality checks and proper strategies just as other care organizations are already doing. Externally, the same organizations will have to give measures of standard quality results to a number of players, accreditation and regulatory bodies (Mcfarlane, 2014).

Despite the successes, ACO has been faced with some shortcomings in their attempts to improve the quality of healthcare. One challenge that has arisen over ACO reliance is the lack of specificity concerning the implementation of this program. In addition, ACO has always been associated with a high initial cost and as well a high maintenance cost and this undervalues its aim of cost reduction. ACO has also been in conflict with the antitrust laws due to their model of providing low quality care, leading to legal concerns (DeVore & Champion, 2011). ACO model is a real or an imitation of organizations that have the obligation of giving care to a set of patients and thereby realizing desirable objectives and also effective in limiting cost. The underlying driving mechanism of ACO is the financial bonuses that ACO will realize after meeting quality standards and cost (Lewis et al, 2013). It is important in reduction of service duplication, availability of resources and advance infrastructural investment, for example, IT, process redesigning, and determining of processes that advocate for the clinical observation and engagement of patients.

Current and new ways of providing financial reimbursement, for example, ACOs, will help in streamlining the contribution that associates with the improvements of the health care system (Bao, Casalino, & Pincus, 2013). However, for the achievement of the full potential of payment reforms, careful attention should be directed towards the development of technological competences of organization of health care providers that will achieve a high value care and accountability by using ACOs. A number of these operational concerns are vital and should receive continued investigation methods. 

To conclude, there is an exciting opportunity for organizations and facilities for improvement in the service delivery in ACO that results in customers’ satisfaction and opportunity to receive financial benefits. Transformation to ACO by any organization will require leveraging of health IT for the analysis of information about patients and providers and give a report on quality and accruing costs. In addition, they will have to come up with an excellent ACO strategy that will look into adjustment of how the workflow and clinical operation of organizations’ results after implementing an ACO.

 

References

Bao, Y., Casalino, L., & Pincus, H. (2013). Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization. Journal of Behavioral Health Services & Research. 40: 121-13

DeVore, S., & Champion, R. W. (2011). Driving population health through accountable care organizations. Health Affairs, 30(1), 41-50.

Kuramoto, R. K. (2014). Specialties: Missing in Our Healthcare Reform Strategies? Journal of Healthcare Management. 59: 89-94

Lewis, V. A., Colla, C. H., Carluzzo, K. L et al. (2013). Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation. Health Services Research. 48:1840-1858.

Lieberman, S. M., & Bertko, J. M. (2011). Building regulatory and operational flexibility into accountable care organizations and ‘shared savings’. Health Affairs, 30(1), 23-31.

Macfarlane, M. A. (2014). Sustainable Competitive Advantage for Accountable Care Organizations. Journal of Healthcare Management. 59: 263-271

Stenson, J, (2013). Thompson M. Accountable Care Organizations-The Promise, Perils and Pathway to Value for Plan Sponsors. Benefits Quarterly. 29: 8-13

 

 

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