As a proposed pillar of community health merging ambulatory primary care with multi-specialty, hospital, rehabilitation and other healthcare entities and needs, accountable care organizations (ACOs) will be linked through innovative EHR and health IT platforms to achieve seamless and comprehensive medicine. Download our ACO fact sheets to learn more.
Public and private accountable care organizations represent a large focus of care delivery reform, yet not everyone knows what they are or how they work. They contain common characteristics and/or requirements that are building blocks for success.
Specific guidelines under federal laws and regulations spell out how a Medicare ACO is established and operated, from structure to practices. While private/commercial ACOs are not subject to these same legal requirements, most follow recognizable establishment and business practice patterns.
A major goal of accountable care and ACOs is to increase the quality of care delivered to patients. Medicare ACOs provide detailed measurements by which to determine their success.
Providers represent the lynchpin of ACO success as directors of care coordination in the model. To achieve quality and savings goals, physicians must understand their evolving role within the functionality of the organization.
Patients and the quality of care they reserve lie at the heart of the mission of accountable care and ACOs. As an active participant within the ACO structure and with their own health, they must be educated to maximize the benefit offered to them.
Hospitals will play a pivotal role in public and private/commercial ACOs as main care coordination centers. As such, hospitals must take into consideration certain requirements and challenges that uniquely affect their participation in an ACO.
States around the country are actively beginning to pursue and lay the groundwork for ACOs at the state Medicaid level. These entities are set up and function much like other ACOs through savings sharing and quality reporting, but exist under the state’s auspices.
On a parallel track with the Medicare Shared Savings Program, private/commercial ACOs are forming and gaining traction across the country. These entities differ from Medicare ACOs in key ways in that highlight their independence from government oversight.
While they contain similar goals as other delivery models such as HMOs and Patient-Centered Medical Homes, ACOs differ with respect to their structure and function. These key differences highlight the new role ACOs are expected to play and ways to achieve previously unseen quality improvements and cost savings.
Due to the relatively unique composition of ACOs and partnerships they create to achieve more highly integrated care, questions arise about their legal viability. The Accountable Care Act (ACA) and subsequent regulations seek to ensure that ACOs are able to accomplish their mission by shielding them from undue interference with legal and regulatory barriers.
ACOs and accountable care in general cannot be successful without significant integration of health information technology into the entire care coordination model. Data transfer across platforms and practices will allow providers to increase the quality of care while lowering the overall cost.