This essay examines the approach of accountable care organizations in achieving lower expenses and the importance of its comprehension by nurse practitioners. ACOs were formed to improve patient care, strengthen public health, and cut costs. ACOs use tools such as prospective patient attribution, hospitalization rules, and high levels of shared risk to manage costs while providing care of somewhat questionable quality. A nurse practitioner must comprehend ACOs in order to reduce service duplication, ensure practical problem-solving, and optimize care quality.
The primary function of an ACO is to involve healthcare systems and suppliers in the transition to a population-focused, risk-based arrangement. Another initiative is the implementation of alternative payment models, which are becoming more popular among commercial health plans. ACOs implemented vital design elements such as prospective patient attribution, a three-day hospitalization rule waiver for high-efficiency nursing care admissions, and high levels of shared risk and reward (Burns & Pauly, 2018). Such designs enable immediate hospitalization in a facility, avoiding inpatient admission costs. Generally speaking, current ACO findings are mixed, with some studies indicating lower hospital admissions and reduced hospital stays than in traditional linear. Others argue that short-term hospitalization rates can lead to poor patient care (Stokes et al., 2018). Furthermore, some private integrated systems have been more impactful than Medicare ACOs in attaining maximum care quality while reducing costs (Reindersma et al., 2022). As a result, the scientific community continues to doubt the quality of care provided.
In contemporary realia, nurses’ role within the medical facility has expanded. Nurses perform such duties as service delivery, disease management, data processing, and process management, among others. Attempting to eliminate service duplication and errors occurring during the treatment are the primary goals of ACO to ensure decent patient service (Bagwell et al., 2017). Nurses may be the ideal supplement for analyzing the existing assets and recruitment levels, as well as an effective manner of resolving issues, as ACOs strive to improve the quality of care and delivery.
The healthcare payment system is experiencing a profound shift as providers and customers transition from quantity to value with the help of ACOs. Accountable care organizations reduce costs by implementing essential design elements into the system. In addition, ACOs’ understanding is a crucial skill for medical workers for healthcare development.
References
Bagwell, M. T., Bushy, A., & Ortiz, J. (2017). Accountable care organization implementation experiences and rural participation. JONA: The Journal of Nursing Administration, 47(1), 30–34. Web.
Burns, L. R., & Pauly, M. V. (2018). Transformation of the health care industry: Curb your enthusiasm?The Milbank Quarterly, 96(1), 57–109. Web.
Reindersma, T., Sülz, S., Ahaus, K., & Fabbricotti, I. (2022). The effect of network-level payment models on care network performance: A scoping review of the empirical literature. International Journal of Integrated Care, 22(2): 3, 1-61. Web.
Stokes, J., Struckmann, V., Kristensen, S. R., Fuchs, S., van Ginneken, E., Tsiachristas, A., Rutten Van Mölken, M., & Sutton, M. (2018). Towards incentivising integration: A typology of payments for integrated care. Health Policy, 122(9), 963–969. Web.