The Driving Force Behind ACOs

Affordable Care Organizations (ACOs) are “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients, ” as defined by the Centers for Medicare & Medicaid Services (CMS) in the Affordable Care Act.

The methodology behind Accountable Care Organizations is to have a more fluid approach to patient care.  Providers within an ACO are held jointly accountable for the health of their patients, giving providers financial incentives to cooperate and save money by encouraging preventative care and avoiding unnecessary tests and procedures. In order for ACOs to succeed providers must seamlessly share information. The motivation for providers is those that meet quality targets and save money would keep a portion of the savings.

Let’s use a car as a metaphor. Right now you may take your car to Jiffy Lube for an oil change, Discount Tires for tire rotation, Just Brakes to get your brakes changed and Dent Zone to have a dent repaired.  Obviously, none of those facilities talk to each other or share information about your car.

With an ACO it would be as though all those businesses had access to the same information about your car. They would know the exact date of an oil change, the type of oil used, the last time the tires were rotated or any other work done to the vehicle and any advice provided about maintaining your car.   But they don’t, and neither does your Provider today.
In order to get a 360◦ view of your health or your car, things would need to change in how each of these facilities document information, where that information is stored, and with which facilities they want to be associated.

Why did Congress include ACOs in the Affordable Care Act?

In short, we have a huge national debt and lawmakers are looking for ways to reduce it. Medicare is the prime target. Per Kaiser Health News as baby boomers continue to enter into retirement,  “the costs of the program for elderly and disabled Americans are expected to soar.”

If the program is successful, Health and Human Services (HHS) estimates that ACOs could save Medicare up to $940 million in the first four years.

How will ACOs change patient care?

Today patient care is based on fee for service similar to car maintenance. You take your car for its annual inspection (annual physical).  You don’t take your car to a mechanic until you notice something is wrong (aches and pains), you ignore the check engine light (warning signs) until you make the time to get it fixed or have the money to do so. By the time you take your car to the mechanic you might have blown a head gasket or worse, which cost far more than if you had just had the oil leak fixed initially.

The presumption is with an ACO patients have access to more comprehensive care by the collaboration and coordination of care with other providers within the ACO.

According to Tom Doerr, director of innovation research at Lumeris in a Physicians Practice interview, a successful ACO model would entail many factors.
•    Doctors would need to avail themselves to more patients. An option to accomplish this would be open-access scheduling and more same-day appointments.
•    Primary care physicians would provide more personalized patient visits and provide the  majority of a patient’s needs; only referring patients to a specialist with uncommon problems.
•    Physicians would offer individualized care plans that address prevention, screening goals, and advanced care planning.
•    Physicians would educate patients and set goals with patients to help guide patients to better health.
•    Physicians would collaborate with other providers and other healthcare systems, including managing transitions of care between healthcare settings.
•    Payers would need to provide more information regarding claims to physicians.
•    Physicians would also need to focus on providing more non face-to-face care to patients, such as E-visits.

By bringing about all these changes the speculation is ACOs will help reduce the overall cost of patient care. While the theory is good there are many pieces involved in developing a successful ACO model,  making it difficult and somewhat costly to create.

One thing is for sure:  ACO’s will change the face of healthcare as we know it.

Do you think ACO’s will help physicians save money and make patients healthier?

Sources: www.kaiserhealthnews.org