Introduction
High health care costs stimulate the state to develop various forms of financial organization of medical institutions. Members of health insurance programs may receive assistance from a managed care organization (MCO) or an accountable care organization (ACO). The MCO is a group of professionals who support patients; in this model, the client pays only for the care provided.
ACO has a more flexible patient support plan because medical staff work together to provide the best care. Collaboration of medical professionals avoids the patient taking interacting drugs and repeating medical tests. The ACO approach reduces medical costs while keeping care at a high level.
A Brief History of MCO and ACO and Initial Purpose
ACO refers to a group of health care providers who voluntarily coordinate patient care. The initial logic behind the introduction of ACO was to reduce healthcare costs to improve the quality of services provided (Wilson et al., 2020). For patients, ACO can serve as a highly integrated system of providers who work together to benefit each patient. Instead of switching between disparate doctors and hospitals, patients receive coordinated care that should deliver better results at lower cost. ACO is a relatively new model that has emerged to minimize healthcare costs, both on the part of patients and the state.
MCOs arose much earlier than ACOs and have some differences, although both forms of organization were planned to reduce the cost of health care. MCOs were established in 1973 to provide a link between patients and providers (Newbrander & Eichler, 2018). The purpose of the MCO is to provide cost-effective and efficient patient care. The MCO can recommend the appropriate treatments, the duration of stay in the hospital, and effective medications. MCO can provide access to high-quality health care at affordable prices.
Population Groups
ACOs create financial incentives for collaboration and information sharing to ensure coordinated, high-quality health care delivery. Coordinated care means that providers share clinical information about their patients with clear expectations about their role. Coordinated care is most beneficial for older people who frequently visit health facilities and those with chronic illnesses. Since the elderly and chronic patients often experience extensive symptoms, it is beneficial for patients to have a facility that can provide a multi-specialty medical team. A collaborative approach allows patients not to waste time visiting individual specialists, significantly reducing costs.
MCOs must have an extensive network that includes a sufficient number of providers. These types of care should include primary and specialty care specialists, hospitals, home care agencies, and physical and mental health professionals. Despite the vastness of the network, health care providers do not work together as a team. Due to the extensive range of services, MCOs are likely more beneficial for patients with an urgent medical problem. The MCO aims to help vulnerable low-income patients who would go to a health facility in case of urgent need.
The Role of the Nurse in Interacting with MCO and ACO Patients
The nurse’s role will differ when working with MCO and ACO patients. When working with ACO clients, the nurse acts as a full medical team member and must provide input to the overall collective approach to patient health. The team approach focuses on communication centered around the patient, encouraging clinical interaction, and nurses as the main agents (Zalon et al., 2019).
Psychiatric mental health nurses will work with stressful conditions, patients with senile mental deterioration, or chronically ill patients in need of assistance. With MCO clients, the nurse will become involved only with the attending physician, who is essential in fully informing and ensuring communication with the patient. Clients may vary in needs and conditions, and the psychiatric mental health nurse will assist people with mental health issues.
Impact of Financial Models on Patients and Nurses
In both ACO and MCO, the system aims to provide practical assistance at minimal cost; however, in the first case, through a collaborative approach, and in the second, through cost reduction. In both cases, the patient can count on effective and affordable assistance. ACO is a better option, since it provides a deeper approach but can be more costly for the patient. MCO allows the client to get help at a minimal cost, but this can be time-consuming and may not have the desired effect.
Regardless of the approach to funding, the nurse’s goal in both cases will remain high-quality patient care to achieve the best treatment outcomes (ANA, 2015). However, nurses are more involved in the team at ACO, which allows them to learn faster and grow professionally, but the range of responsibilities also increases. In MCO, nurses perform their direct functions, but can be confused due to miscoordination without a collaborative approach.
Conclusion
The high health care costs make it necessary to look for ways to solve the problem while maintaining the effectiveness of care. MCOs and ACOs are designed to reduce costs, both of which assume that the patient receives high-quality care at an affordable price. Despite its novelty, the ACO model already demonstrates high rates of cost-benefit while providing effective care (National Academy of Medicine, 2021). The nurse’s role is to communicate with the collaborative team at ACO and become an informer at MCO. The ACO model will expand, and a team approach to patient deterioration will become an effective cost reduction method.
References
American Nurses Association. (2015). Code of Ethics with Interpretative Statements. Ethics Standards. Web.
National Academy of Medicine. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. The National Academies Press. Web.
Newbrander, W., & Eichler, R. (2018). Managed care in the United States: its history, forms, and future. In Recent Health Policy Innovations in Social Security (pp. 83-106). Routledge.
Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes and costs: A rapid review. Journal of Health Services Research & Policy, 25(2), 130-138. Web.
Zalon, M.L., Patton, R.M., Ludwick, R. Nurses Making Policy: From Bedside to Boardroom. (2019). Springer Publishing Company.