The centers for Medicare and Medicaid define an accountable care organization as a group of medical professionals and hospitals, whose aim is to share medical and financial responsibilities for coordinated care to patients (McCarthy, 2013). The team members unite to provide harmonized and high eminence care to the Medicare patients, who visit the medical institutions. The coordinated care that is provided assists in ensuring that patients, particularly the chronically ill patients, have access to timely and quality care. Additionally, it helps in preventing medical errors from occurring as well as reducing pointless replication of services. If the ACO programs become successful, they result in saving the cost of treatment for the Medicare patients. Other outcomes may include improved quality of care, improved transitions, cost effective utilization of healthcare resources in addition to increased patient activations (McCarthy, 2013).
However, some critics feel that ACOs were established to reduce the impacts of great minds in the health care, as it is delivered today. The claim is false since taxpayers and innovations have driven most of the changes in the financial structures in the United States. Most of the taxpayers are well-informed about the situation surrounding medical care thus, move from the ancient models to new modern models for service payments such as Medicare programs.
Unique features of Oregon in delivering coordinated care
The Health Share of Oregon is a non-profit organization that was started in 2012 with the intention of offering medical services to the Medicaid beneficiaries. Oregon Health Share has come up with short-terms intensive care management in addition to mental health services for patients with psychiatric hospital admission (Maust, Oslin & Marcus, 2013). Additionally, they have deployed mobile specialists, who meet the patients at the hospital and then do the follow-up during the transition and outpatient care periods. The local mental health crisis programs have been established in each county to ensure that mentally ill patients connect to the community-based services as well a support. It helps the organization to reach out to a wide variety of patients; both in and outpatients (Maust, Oslin & Marcus, 2013). The mental health agencies involved are working towards the attainment of shared performance while monitoring technique across all the networks. The program has assigned health resilience specialists, who offer advice to patients and identify the problems that various patients from the community face for a lasting solution to be established.
The initiatives are aimed at reducing the patients visiting the emergency department to pool the resources, which are readily available towards the provision of the primary care to the patients. The health share program ensures improved transitions, cost effective utilization of healthcare resources in addition to increased patient activations. In addition, the state’s payment model established in Oregon has led to increased flexibility among ACOs to utilize resources to cater for non-medical issues such as housing and employment (Abramsky, 2013). The organization believes that it is necessary to eliminate an illness rather than treating it later to ensure that the patients are out of the chronic situations. The primary mission of the organization makes it unique from other organizations since it relates to the establishment of an integrated community for the health systems. The mission and vision statements make the organization unique from all the others in the same sector.
Why states are experimenting with distinct models of integrated care
Oregon has established various models of integrated care to ensure that they provide quality and affordable care to all patients. It has established a working plan for special needs populations to provide inclusive Medicare. They have established patient-centred medical homes where patients with the complex or chronic diseases are accommodated. People with behavioral problems and social needs such as the mentally ill patients can obtain quality care from medical professionals and social workers in the institution. Oregon has established the financial alignment model to ensure that care is provided at the lowest cost possible (Abramsky, 2013). The health share program ensures improved transitions, cost effective utilization of healthcare resources in addition to increased patient activations, as mentioned earlier. In addition, the state’s payment model established in Oregon has led to the establishment of flexible ACOs, which utilize resources that cater for non-medical issues such as housing (Stecker, 2013). For instance, they can provide conditioning devices to homes with the chronic conditions to prevent exacerbations thereby reducing hospitalization.
The program has assigned health resilience specialists that offer advice as well as medical care to patients. The specialists also help the patients to identify the problems that they face. It has also established a patient and family activation program to ensure that heath assessment and improvement plans are carried out effectively. Additionally, there is the integration of technology to analyze, store and organize health records to ensure that coordination in care management among patients is achieved. The electronic records management is essential in making the operations of the organization fast, accurate, reliable and easily accessible when needed (Stecker, 2013). As such, Oregon uses the electronic system to track the progress of individuals and care teams to check whether they have hit the target performance that is improving the quality of Medicaid beneficiaries.
Are ACOs a viable model to reduce the rate of growth in per-capita Medicaid spending?
Based on the outcomes of the already functional programs, it is valid to say that ACO models can reduce the overall cost of improved care. The ACO programs have been experimented through pilot studies to evaluate their effectiveness in attaining the goal of reducing the growth level of the per-capita Medicaid expenditure. The ACO goals have been made possible by the support from the transformation grant, which is estimated as $3.4 million in addition to $17.3 million from the health common grants (Klein, McCarthy & Cohen, 2014). Medical homes established to cater for the needs of the special needs patients also helps in the reduction of cost that is used for hospitalization and emergencies in Oregon. For instance, hospital admissions have reduced from 6.5% to 5.7% in a year while the number of emergencies have declined from 12.6% to 11.6% (Klein, McCarthy & Cohen, 2014). Therefore, ACOs can reduce the overall cost since there has been an increase in 1% per capita payments in the first year (Klein, McCarthy & Cohen, 2014).
In 2013, there was an 18% decline in emergency department visits and 80% of the patients enrolled in the medical homes thereby saving 16% of the budget (Abramsky, 2013). However, health care and ACOs aim at saving $32.5 million through a decline in the number of hospitalizations based on the results of the pilot programs carried out earlier. In 2014, the Medicare expenditure as per the recipient resulted in 2% per annum reduction compared to the enlargement within the GDP (Klein, McCarthy & Cohen, 2014). From the statistics and the data documented, it is justified to argue that the reduction in the cost is attainable by ACOs within a short duration.
References
Abramsky, S. (2013). John Kitzhaber's Oregon Dream The third-term governor is rethinking healthcare and education in holistic ways. NATION, 296(24), 23-26.
Maust, D. T., Oslin, D. W., & Marcus, S. C. (2013). Mental health care in the accountable care organization. Psychiatric Services, 64(9), 908-910.
(Klein, McCarthy, & Cohen, 2014). Accountable care organization program cuts costs and improves care, the report says.
Stecker, E. C. (2013). The Oregon ACO experiment—bold design, challenging execution. New England Journal of Medicine, 368(11), 982-985.
Klein, S., McCarthy, D., & Cohen, A. (2014). Oriented Approach to Accountable Care for Medicaid Beneficiaries.
