Every year, you may hear more and more about Accountable Care Organizations. Generally referred to as ACOs, these are groups of doctors, hospitals, and other health care providers that come together voluntarily to give coordinated high-quality health care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors (Centers for Medicare, 2015). As a health care administrator, you must ensure that you understand the various types of health care organizations available for your facility, your employees, and your patients.
Evaluate one of the programs best practices that have been and continue to be effective at promoting population health.
Accountable Care Organizations (ACOs) have been created with the voluntary collaboration of doctors, hospitals and health care providers to provide high quality health care to Medicare patient. The Accountable Care Alliance of Ventura (ACAV) is one of the examples of an ACO that has been established with the vision of nurturing relationship within changing health care environment. The focus of Ventura ACO is to engage patients and health care professional through innovation in service. The community Memorial Health System formed the ACAV ACO to provide better service and experience to patients. It has been mapped to participate in the Medicare Shared Savings Programs to improve health of Medicare beneficiaries (Community Memorial Health System, 2017). This article evaluates and discusses one of the program’s best practices for promotion of population health.
ACAV is responsible for engaging in the Shared Savings Program. The core purpose of the program is to promote better health for individual and population and reduce expenditures in health care service. The advantage of the Shared Saving Program for ACOs like ACAV is that it offers alternative payment model to ACO so that they can track and choose the best arrangement that is suitable for the organization (Centers for Medicare & Medicaid Services, 2017). Hence, coordination across items and services for Medicare FSS beneficiaries is possible with this program.
The Shared Saving Program was the reason for large number of coverage and expense for Medicare beneficiaries. ACAV accepted the only upside risk in exchange of smaller maximum shared savings rate and in the first year only, ACAV could spent $9,671 for their beneficiaries. Hence, by adapting risk based payment contract by means of Shared Savings Program, large access to preventive care was possible. It improved health of the population and reduce the duration of hospital stay. The program enables ACAV to focus on quality performance benchmarks and promote cost savings for clients. With greater focus on population health management, Physician Group Practice (PGP) Demonstration was also implemented by ACO. This was a initiative to use incentive as a strategy to encourage physicians to provide high quality care and maintain health of patients (Health Care Incentives Improvement Institute, Inc. (HCI3), 2017). Hence, this pay for performance initiative for physician resulted in greater earnings for physicians as well cost efficiency within the health care system. It also promoted realization of the core goal of ACO.
From the overall review of the role of Shared Savings Programs, it can be said this initiative played a major role in health improvement of population and improving performance of physician. ACAV chose a suitable risk based payment options to spend for beneficiaries and coordination among health providers further enhanced the commitment to provide high quality care at lower cost. The PGP can be regarded as the most beneficial initiative as part of the Shared Savings Programs as it help to overcome all disparities and take appropriate quality measures for chronic diseases like hypertension, diabetes, congestive heart failure and other cardiovascular disease. Evidence proves that very small percentage of Medicare beneficiaries account for spending for multiple chronic disease and PGP ensures coordinating care for chronically ill patient (Veroff, Mar & Wennberg, 2013). Hence, programs and initiatives implemented by ACO strengthen the health care performance and improve population health.
References:
Centers for Medicare & Medicaid Services. (2017). About the Program, Cms.gov. Retrieved 16 December 2017, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/about.html
Community Memorial Health System. (2017). About Accountable Care Alliance of Ventura ACO, Cmhshealth.org. Retrieved 16 December 2017, from https://www.cmhshealth.org/aco/about.shtml
Health Care Incentives Improvement Institute, Inc. (HCI3). (2017). Shared Savings Implementations, Hci3.org. Retrieved 16 December 2017, from http://www.hci3.org/thought-leadership/why-incentives-matter/shared-savings/shared-savings-implementations
Veroff, D., Marr, A., & Wennberg, D. E. (2013). Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Affairs, 32(2), 285-293.
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