Accountable Care Organizations (ACO) were introduced to supervise and assist Medicare and Medicaid programs. More than 900 ACO have established 1300 contracts with private and public hospitals across the country since 2010 to manage payments of Medicare patients (Kaufman et al., 2018). This model holds healthcare organizations accountable for the cost and quality of care by creating a system of value-based payment, meaning that hospitals are paid for the outcome, not per service (Kaufman et al., 2018). Furthermore, “ACO contract components include financial accountability, quality measurement, and population health data sharing,” resulting in improved care and cost reduction (Kaufman et al., 2018, p. 257). For example, the nominal savings were $700 per fiscal year per cancer patient (Kaufman et al., 2018). However, there was no significant cost reduction for surgical procedures with the ACO model (Nathan et al., 2019). It appears that the benefit of this program is not evident for all specialties yet. Still, I believe that the principle of value payment is fair for patients because it ensures that high-quality care is provided to maximize favorable outcomes.
Reliance Healthcare is an example of a successful ACO that partnered with emergency departments (ED) in Michigan to coordinate care for Medicare patients. This organization consists of three groups: clinicians, an information technology (IT) team, and managers (Centers for Medicare and Medicaid Services [CMMS], 2020). The primary goal of Reliance Healthcare in this partnership with EDs was to minimize healthcare costs by preventing unnecessary hospitalizations through an organized work of reliance nurses, managers, and IT departments (CMMS, 2020). The recent report stated that this program could prevent, on average, two avoidable admissions per day from 2014 to 2020, leading to significant cost reduction of care (CMMS, 2020). I think that Reliance Healthcare should continue working with healthcare providers, and forming more contracts because unnecessary hospitalization is a big issue in our hospitals; thus, an ACO control can prevent needless expenditures.
References
Centers for Medicare and Medicaid Services. (2020). Reliance Healthcare’s emergency department care coordination program. Web.
Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2018). Impact of accountable care organizations on utilization, care, and outcomes: A systematic review. Medical Care Research and Review, 76(3), 255-290. Web.
Nathan, H., Thumma, J. R., Ryan, A. M., & Dimick, J. B. (2019). Early impact of Medicare accountable care organizations on inpatient surgical spending. Annals of Surgery, 269(2), 191–196. Web.