Question one:
The patient’s choice of provider and access to care will not be limited under ACOS. Under ACOS, the patient is not restricted to a specific service provider within the organization. For instance, if the patient has personal physician, he or she will continue to see the same physician even after joining the organization. If he or she lacks a personal physician, then one is assigned to him or her. Research has shown that patients frequently seek medical care outside their ACOS and many move from one ACO to another every year. This roaming has, however, made it difficult to manage the quality and cost of health care.
Question two:
Yes, it is a reality that with an ACO, you will likely have fewer repeated medical tests because your doctors and hospitals will share information and coordinate your care. An ACO is patient centred, i.e. hospitals, doctors and other health care providers voluntarily come together with the aim of giving high quality service to a group of patients at low cost. Take for instance, a 65 year old man, with back pain, diabetes and hypertension. He visits an orthopaedic physician for his back pain, a primary care physician for diabetes, and a cardiologist for hypertension. The chances that he will do repeated tests and receive the same prescription, during each visit, are high. This is because all the specialists do not have access to his medical history. Under an ACO, all the specialists will have access to his medical history, and, therefore, know the tests that have already been performed. Furthermore, the physicians can interact easily to ensure quality care is given to the patient – avoid the same prescriptions and manage disease complications effectively.
Question three:
The main aim of ACOS was to lower the cost of health care while improving on the quality of care. The service providers within an ACO take responsibility for their patients. Financial reward is offered, by Medicare and other health insurance companies involved. The ACOS that successfully reduces the cost of managing a chronically ill patient, and at the same time provides high quality health services to the patient is rewarded with bonuses. The ACOS that fail to meet the health quality benchmark receive a penalty. The main goal is to do away with unnecessary repetition of services e.g. tests, boost preventive efforts, which, in the end, reduce the need for expensive services such as hospital admissions. Patients are not restricted to a specific ACO. It is the service providers that join the organization and not the beneficiaries.
Primary care physicians are the must have in each ACO. The organizations are governed by primary care physicians and not insurers. If they meet the governance conditions – quality performance and transparency, then they will be able to lower the cost of care. Although the implementation of Medicare ACO program is faced with many hurdles, the small strides it has it has made towards lowering the cost of healthcare cannot be overlooked. According to Centers for Medicaid and Medicare Services, in its first year, ACOs saved about $380 million. 114 Shared Savings Program ACOs were involved in the study. 54 of them managed to spend less than they had projected. Only 29 managed to make enough savings and qualified to keep some of it.
References
accountablecarefacts.org. (2014). Top Questions About ACOS and Accountable Care. Retrieved from Accountable Care Facts: http://www.accountablecarefacts.org/topten/what-is-the-difference-between-a-medical-home-and-an-aco-1
Gold, J. (2014, April 16). FAQ On ACOs: Accountable Care Organizations, Explained. Retrieved from Kaiser Health News: http://www.kaiserhealthnews.org/stories/2011/january/13/aco-accountable-care-organization-faq.aspx
Mathews, A. W. (2012, January 23). Can Accountable-Care Organizations Improve Health Care While Reducing Costs? Retrieved from The Wallstreet Journal: http://online.wsj.com/news/articles/SB10001424052970204720204577128901714576054?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052970204720204577128901714576054.html
