This essay covers the topic of Accountable Care Organizations (ACOs). ACOs are health care organizations envisaged in the Affordable Care Act with a health care delivery and reimbursement model that is based on quality metrics. ACOs are responsible for providing quality care and reducing the total cost of care and account for their services to patients and the payers of health care services. The focus of this essay is the benefits and the unintended consequences of ACOs.
Benefits of ACOs
ACOs function on a delivery model of individual health providers and organizations coming together to coordinate care delivery. An immediate benefit of ACOs is increased access to quality care. ACOs support patient centered medical homes which are meant to enhance access to care under special situations such as telephone appointments, after-hour access, same and next day appointments, personal clinicians, electronic patient portals and population management (Longworth, 2011). Another benefit of ACOs is that patients will have fewer tests and no futile treatments compared to care in conventional health facilities which are reimbursed based on services offered and not quality. This is because the reimbursement model of ACOs is based on the quality of care offered and not fee for service. This will reduce duplicative tests and the care providers will be recommending the most accurate and conclusive tests in order to improve the quality of care. The successful implementation of ACOs is based on leveraging on electronic health records and single points of contact. This will benefit the organizations by reducing paperwork and human errors in medical records. Patients will benefit by having one care provider to contact for all health issues and engaging the care provider in online patient portals.
Unintended Consequences of ACOs
Despite the benefits of ACOs, this model of health care where reimbursement is based on the quality of services rather than quantity of service has some unintended consequences. For instance, the Medicare Shared Savings Program, which is the leading Medicare ACO program, uses a quality benchmarking and rebasing method that makes is hard for even the top performing ACOs to have sustainable success (Harvey et al., 2013). The long term viability of the program is threatened by lack of sustainable success thereby compromising the health of the people who rely on ACOs to access health care services. The ACO model reduces the cost of health care using mechanisms such as care coordination, disease management and aligning financial incentives for the organizations and care providers (Burns & Pauly, 2012). This is the same mechanisms that formed the integrated delivery networks implemented in the 1990s that failed to control the cost of health care services or increase the access to health care services. The managed care services failed due to managed care companies restricting the interventions care providers could take. Under the ACO model, physicians will be reluctant to use some novel and trial interventions which are not backed by strong evidence, but can save a patient’s life since such procedures do not have proven efficacy and quality. This challenge can reduce the quality of care and the options of care available to patients even for those with life-threatening conditions for which complementary and alternative medicine options may exist (Gilmour et al., 2011). Additionally, fewer hospitals will be consenting to participate in clinical trials for new methods since these will need to separate their patients as a negative outcome in the trials may reduce the overall quality rank of a hospital thereby reducing their reimbursement.
References
Burns, L. R., & Pauly, M. V. (2012). Accountable care organizations may have difficulty
avoiding the failures of integrated delivery networks of the 1990s. Health Affairs, 31(11), 2407-2416.
Gilmour, J., Harrison, C., Asadi, L., Cohen, M. H., Aung, S., & Vohra, S. (2011). Considering
complementary and alternative medicine alternatives in cases of life-threatening illness: applying the best-interests test. Pediatrics, 128(Supplement 4), S175-S180.
Harvey, H. B., Gowda, V., Gazelle, G. S., & Pandharipande, P. V. (2013). The Ephemeral
Accountable Care Organization—An Unintended Consequence of the Medicare Shared Savings Program. Journal of the American College of Radiology, 11(2), 121-124.
Longworth, D. L. (2011). Accountable care organizations, the patient-centered medical home,
and health care reform: What does it all mean?. Cleveland Clinic journal of medicine, 78(9), 571-582.
