Instruction:
Heath share of Oregon
ACOs
The phrase ACO is an acronym for Accountable Care Organization. This term refers to groupings of hospitals, doctors, and other healthcare providers. The involved parties voluntarily come together to give high quality coordinated care to Medicare patients. Essentially, ACOs came up as a result of the poor service delivery in public hospitals. It is worth noting that patients have for a long time complained about the high cost of Medicare. Furthermore, they also experience reduced healthcare delivery that is not flexible to their needs. The legacy system adopts a “one size fits all healthcare mechanism" (Berwick, 2011). Different patients have different medical needs. Thus, healthcare facilities need to have high levels of organization to enable them to meet the patient needs adequately. To fill this gap, Accountable Care Organizations come into play.
Features of ACOs
Healthcare providers typically lead Accountable Care Organizations. They form a strong primary care base that is collectively responsible for quality and comprehensive per capita costs. These costs run across the entire care continuum for a patient population.
Payments get linked to quality improvements which reduce overall costs. In such a manner, it helps in facilitating the functional efficiency.
These organizations have reliable measurements of performance to facilitate efficiency standards of operation. Evidently, these measures aim to support improvement and provide confidence in the fact that advancement in proper care methods leads to savings.
What makes Oregon Unique?
First, Oregon received $1.9 billion from the Centers for Medicare and medical services over a five year period to make up for a budget shortfall in its Medicaid program. This financial support enabled the state to implement an effective program aimed at reducing per-capita Medicaid spending. Oregon then implemented a reform plan that required any health plan or provider participation in the Medicaid program to join or form a regional coordinated care organization, abbreviated as CCO. This institution would then have the responsibility of meeting quality improvements and cost containment goals.
The results proved remarkable. In the month of June 2014, approximately 227,000 Medicaid beneficiaries got enrolled in Health share. Furthermore, the program proposed different health care improves in various aspects of Medicaid. They include the care management of patients with complex, costly needs, patient family engagement and activation. Further, other services include integrated data analytics and supportive payment models as well as financial incentives to the organizations.
Currently, federal governments of the different states are experimenting with the various models of integrated care organizations. They are constantly trying out different methods to determine the one that best suits them. Before we delve deeper into the reasons why various states are testing various systems, it is important to identify the various types of Accountable Care Organizations – ACOs.
Types of ACOs
Full spectrum integrated
These ACOs provide all healthcare aspects directly to the patients. They are typically dominated by vast delivery networks that are integrated. Interconnected networks ensure that they have a large pool of expertise that can deliver the best healthcare possible. However, such organizations still view heath facilities as drivers of revenue. This fact poses a challenge in that focus gets mainly placed on income generation than service delivery.
More savings can get made through reducing admissions than reduce the duration of stay for the admissions. Lastly, they place a higher focus on inpatient than ambulatory to reduce admissions.
Independent physician groups
Single physician groups own these organizations. They usually sign no contracts with other providers. Moreover, they do not have ready access capital to expanded physician groups. Only outpatient services get offered directly. Sometimes, they offer hospital or subspecialty services through contracts with other providers. Independent physician groups also have the ability to set up operational agreements with hospitals to manage the health of patients in a much better way.
Independent hospitals
These are ACOs with a single proprietor. They provide direct inpatient services. Outpatient services are also available in the case of integrated health structures. However, they do not give subspecialty care to patients. The main advantage is that they have a lower cost, and the downside is that they provide fewer services than the full spectrum ACOs.
Hospital alliances
These are ACOs owned by individual hospitals. At least one of the hospitals provides inpatient services directly.
Why with different models of integrated care states experiment
Adopting a particular model of healthcare may not meet everybody's needs. Different healthcare models come with different benefits and challenges. Not all patients have the same needs. Therefore, experimenting with various forms of integrated health systems will enable the states to learn some valuable lessons.
Experimenting with different models helps the government enhance collaboration among medical providers. Proper communication n is essential to effectively treat patients. In hospitals, patients receive treatment from different practitioners. Poor communication would, therefore, lead to misdiagnosis of patients. It can also lead to incorrect treatment. Such mishaps in healthcare drive up the cost of healthcare for everyone (Luft, 2010).
The health departments in the federal governments will also get a chance to determine which methods would provide proper care management of patients with simple cost needs. These patients involve those with Psychological issues and chronic ailments. They need highly personalized care that costs a lot of money and needs enhanced expertise. Through trying out different forms of healthcare management, the different states get to determine which systems take into account patient & family engagement including activation. When a patient gets admitted to a health facility, it is important for family members to interact with them frequently. The interaction helps the patient psychologically since it gives him/her an assurance of love and support (Berwick, 2011).
Another aim of experimenting with different systems is to determine the system that best integrates data and analytics. The hospitals will also gain the ability to develop supportive payment models and financial incentives. Finally, the health organizations get to determine and learn the best practices in addressing patient needs
Viability of the ACO model
The ACO model is viable in reducing the growth in per-capita medical spending with the reasons being that ACOs assume the responsibility for overall care quality and cost of patient care. The managed security service providers avail additional funds for meeting cost savings and quality goals. The extra savings get shared among providers (Ginsburg, 2011). They undertake the sharing based on risks distribution options. When risks get distributed, the chances of bankruptcy get diminished. The patients also get empowered with easy access to vast networks of providers with quality health care at low costs. This situation will further enhance competition among ACOs, and the per-capita cost of healthcare progressively goes down.
References
Berwick, D. M. (2011). Making good on ACOs' promise—the final rule for the Medicare shared savings program. New England Journal of Medicine, 365(19), 1753-1756.
Ginsburg, P. B. (2011). Spending to save—ACOs and the Medicare shared savings program. New England Journal of Medicine, 364(22), 2085-2086.
Luft, H. S. (2010). Becoming accountable—opportunities and obstacles for ACOs. New England Journal of Medicine, 363(15), 1389-1391.
