Creation of different types of medical care is encouraged by the rising need to optimize American health care system so that it can satisfy the needs of patients and be affordable. Experts foresee a quick development and implementation of Accountable Care Organizations (ACOs) system, as it has a great potential. ACOs are the networks of health care providers, where physicians can unite their efforts to improve the quality of services and lower the health care costs.
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Better quality and visible positive outcomes of provided care are considered the main goals of ACO model. The topic of this paper is main goals of ACOs model. Summers, Lisle, Ness, Birchfield Kennedy, and Muhlestein explore the issues related to the effectiveness of ACOs in their report “How Accountable Care Impacts the Way Consumers Receive Care” (2015).
The main objective of this paper is to analyze the evidence of the ability of ACOs approach to provide better care and healthier outcomes presented by the authors of the report and determine if ACO approach will accomplish the goals.
How Does the Report Demonstrate the Ability of ACOs Approach to Help Consumers Experience the Better Care and Healthier Outcomes?
The authors of the report believe that ACOs approach will help consumers experience the better care and healthier outcomes and prove their argument by presenting the advantages of the ACO model. To support the argument, the authors begin the report with an extended explanation of what is an ACO. The authors emphasize that in an ACO, payments are focused on the outcome, such as value and quality of the provided care, not volume (Summers, Lisle, Ness, Birchfield Kennedy, & Muhlestein, 2015, p. 2).
The main difference between ACOs and other models of care delivery is defined as the focus on delivering patient- and family-centered care. ACOs encourage partnerships with patients and their involvement in the process of practice improvement.
The next part of the report explores the main benefits of ACOs for consumers. Improved care coordination is regarded as one of the main advantages of ACOs, which brings numerous benefits to the patients. Improved care coordination is aimed at fixing “the fragmented nature of the current health care system” (Summers et al., 2015, p. 3).
It should bring together all parts of the health care delivery system (primary care, laboratories, urgent care, hospitals, etc.) and ensure they work in the most efficient way. Another privilege of ACOs indicated in the report is the maximized use of health information technology (HIT) tools, such as electronic health record (EHR).
EHRs help to avoid duplicative procedures and present all necessary patient data to every specialist involved in the delivery of care. Another HIT tool, a patient portal, helps to have continuous access to medical information by both patients and health care providers. Different types of ACOs are also identified and explained to show how each of the types contributes to providing the better care.
The final part of the report discusses how ACOs can help consumers experience the better care and healthier outcomes. The improvement of the way the patients receive care is the first point considered contributing to the delivery of better services. It is based on the innovative care integration and promotion of patient and family engagement. Another goal of ACOs is ensuring that patients receive the right care at the right time and providing appropriate prevention for common diseases.
The conclusion of the report indicates that though ACOs exist for only several years, certain positive results have already been observed. Such organizations help to move the healthcare system from inefficient and fragmented structure to more effective and integrated structure. However, the authors point to some of the issues that should be considered for providing continuous development of ACOs. They include improving consumer access to quality and cost information and informing the patients how ACO model functions.
The analysis of the report demonstrates that the authors believe that ACOs approach will help consumers experience better care and healthier outcomes because of the orientation of the approach towards providing the integrated health care services and efficient patient and family engagement. The motivation of the practitioners involved in ACOs to provide a high level of quality of work instead of the volume is considered another important reason to find ACOs approach helpful for providing better care.
Will ACOs Accomplish the Goal?
Though the history of employing ACO model is rather short, I believe in its great potential to accomplish the goal of helping consumers experience the better care and healthier outcomes. ACOs can achieve this goal by improving patients’ health and well-being, mitigating “the anticipated shortage in primary care providers”, and lowering the costs for healthcare (Tallia & Howard, 2012, p. 2388).
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In my opinion, the main reason ACOs appear to be able to achieve the declared goals is their orientation towards prevention of diseases. I believe that prevention is the key to providing healthier outcomes. While traditional model in medical care involves focusing on providing care to the patient while the patient is in the office, ACO model is determined to provide continuous care for patient throughout his life paying attention to all aspects of the patient’s life outside the office.
It includes analyzing predispositions, conditions of life, habits, etc. to provide an integral examination of the health state and find solutions needed to eliminate risks of developing certain diseases and promote the patient’s health. Such strategy appears to be very useful for providing great health outcomes and can reduce the cost of healthcare. Camargo, Camargo, Deslich, Paul III, and Coustasse (2014) conducted a research that demonstrates a vital importance of providing more coordination and preventive services for decreasing health care spending (p. 114).
Another factor that appears to contribute to achieving the goal of helping consumers experience excellent care is encouraging patients to participate in the creation of highly customized products. As ACOs approach emphasizes the importance of patient and family involvement in the process of improving health care services, ACO model has a potential to collect patients’ opinions and based on them create heath care products.
Macfarlane (2014) claims that such approach can help to reduce the waste “incurred in the production of non-competitive products and services” (p. 270). I believe that ACO model can provide an efficient level of care by using its methods for encouraging patients to be a part of the process of improving the services.
Another distinctive feature of ACOs that contributes to achieving their goals is flexibility. Patients are not obliged to receive care only from the doctors inside the ACOs network and can choose the practitioners outside the network in compliance with their preferences, without paying extra money. Therefore, ACOs are supposed to put much effort in getting a good feedback from patients, as they can lose their contracts. Such circumstances result in stronger motivation for the participants of ACOs to be competitive and strive for improving the performance.
The adequate level of accountability for clinicians participating in ACOs is one of the keys to the success of such organizations. Fisher and Shortell (2010) indicate the effectiveness of organizing different levels of ACOs based on corresponding payment models (p. 1715). These payment models include shared savings with no risk, symmetrically shared savings with some risk for excess cost, and partial capitation (Fisher & Shortell, 2010, p. 1715).
I believe that such approach can help ACOs to accomplish their primary goals as it supports differentiated system of payments aimed at providing adequate level of accountability for health care workers and, thus, motivating them to provide the highest quality of care.
ACO model has already gained popularity among American health care providers due to its innovative approach to organizing the integrated cooperation of medical workers. In my opinion, more effort should be put in educating health care workers about ACO model and preparing the conditions necessary for employing it.
Auerbach, Liu, Hussey, Lau, and Mehrotra (2013) conducted a study that demonstrates the regional factors that are predictive of ACO formation (p. 1781). These factors include high percent of hospitals affiliated with a system and high percent of hospital revenue from risk-sharing contracts (Auerbach et al., 2013, p. 1786). These data should help to encourage popularization of ACOs by adjusting the factors mentioned above to their needs.
The analysis of the report and other academic sources studying the issues related to the ACOs approach helps to see a great potential of this approach and define its ability to accomplish its main goals, such as providing better care and healthier outcomes for patients. ACO model gives the physicians an opportunity to unite their efforts and provide integrated care bringing better results.
Auerbach, D. I., Liu, H., Hussey, P. S., Lau, C., & Mehrotra, A. (2013). Accountable care organization formation is associated with integrated systems but not high medical spending. Health Affairs. 32. 1781-1788.
Camargo, R., Camargo, T., Deslich, S., Paul, D. P. III, & Coustasse, A. (2014). Accountable care organizations: Financial advantages of larger hospital organizations. The Health Care Manager. 33. 110-116.
Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. The Journal of the American Medical Association. 304. 1715-1716.
Macfarlane, M. A. (2014). Sustainable competitive advantage for accountable care organizations. Journal of Healthcare Management. 59. 263-271.
Summers, L., Lisle, K., Ness, D. L., Birchfield Kennedy, L., & Muhlestein, D. (2015, May). How accountable care impacts the way consumers receive care. The Impact of Accountable Care [Online]. pp. 2, 3.
Tallia, A. F., & Howard, J. (2012). Innovation profile: An academic health center sees both challenges and enabling forces as it creates an accountable care organization. Health Affairs. 31. 2388-2394.