Introduction
The Affordable Care Act (ACA) included accountable care organizations (ACOs) to advance the Triple Aim of raising healthcare quality and patient satisfaction while cutting costs. Changes in payment incentives were intended to achieve this goal, with ACOs eventually being expected to take on adverse risks.
Discussion
According to Trombley et al., through the prepayment of shared savings, AIM offers qualifying Medicare Shared Savings Program (MSSP) ACOs financial assistance (2019). The determination to move away from volume-based payment depended on the nation’s willingness to accept such risk. Doctors are now accountable for wellness issues outside their usual practice areas due to increased patient loads. A value-based system’s requirements may result in a more demanding and unforgiving work environment for doctors.
The model’s objectives include lowering costs while maintaining or improving the quality of care, encouraging the formation of new ACOs in underserved or rural areas, and encouraging smaller current ACOs to take on more financial risk. According to the Centers for Medicare and Medicaid Services (CMS), between 2015 and 2018, the Shared Savings Program (SSP) served as the operating framework for the Accountable Care Organization (ACO) Investment Model (AIM) (2022). Selected ACOs received upfront funding from AIM to invest in staffing and infrastructure. It targeted small, existing ACOs to support their sustained involvement and transition to two-sided financial risk and new ACOs to encourage their formation in rural or low ACO penetration areas.
Conclusion
By transferring varying degrees of financial responsibility for patient outcomes to the provider level, such as doctors and hospitals, rather than the payer level, such as Medicare and managed care organizations (MCOs), where these responsibilities traditionally lie, ACOs are intended to achieve the Triple Aim. Two things cause this shift: The most extraordinary people coordinating care for the patients they serve efficiently are care providers and care teams. Second, providers will strive to enhance patient care coordination and make cost-effective decisions regarding treatments and procedures if their financial compensation is more closely correlated with efficiency and health outcomes. A delivery paradigm can support these traits, lowering costs while improving patient outcomes.
References
CMS Innovation Center (2022). ACO Investment Model. Innovation. Web.
Trombley, M. J., Fout, B., Brodsky, S., McWilliams, J. M., Nyweide, D. J., & Morefield, B. (2019). Early Effects of an Accountable Care Organization Model for Underserved Areas. New England Journal of Medicine, 381(6), 543–551. Web.