According to DeCamp et al. (2014), Accountability Care Organization (ACO) refers to a grouping of health care professionals (this includes nurses, specialists, primary care physicians, and hospitals) who work together as one team to synchronize care for a specific patient group across all care settings. DeCamp et al. (2014) indicate that an ACA plays a critical role in managing its patient group’s health and the costs associated with care provision. The ACO’s conceptualization is based on the notion that well-synchronized care is crucial in enhancing significant improvements in the quality of health care and patients’ wellbeing while minimizing the duplication of services, decreasing risks associated with complications and errors, and lowering costs. The shared savings program by the CMS aims to support health care providers in ACOs to coordinate or work together across various care settings to attain these goals. Other models of ACO serve bigger patient populaces and provide more opportunities for APRNs and nurses to participate or join as equal partners (Kaufman et al., 2019).
How to Play a Part in Accountability
As a care provider, I can play the role of a care coordinator. According to Kerr, Kullgerm, and Saini (2017), the ACO regulations mandate all health care providers in the ACO to synchronize care across various settings; this includes home settings, rehab centers, hospitals, and physicians’ offices. McClellan et al. (2017) further reveal that nurses within the ACO are currently tasked with the duty of coordinating care from various sources, for instance, pharmacists, specialists, and physicians. Secondly, I can participate in the ACO as a communicator. ACO regulations underscore the need for providers to provide patient-centered care. Nurses are, therefore, tasked with the duty of communicating and translating choices associated with medical care and therapy plans to families. Thirdly, as a practitioner, I can assume the role of a quality improvement manager. Pittman and Forest (2015), in their study, posit that ACOs ought to promote or facilitate evidence-based medicine and utilize information to analyze cost and quality measures; this, in turn, enhances the ACO’s capacity to take part in the Medicare shared Savings Program. McClellan et al. (2017) further argue that nurses are proficient in managing data. Currently, approximately forty percent of the hospitals in the U.S engage in the NDNQI to evaluate the processes of nurse outcomes and care. Nurses typically evaluate data and search for innovative solutions aimed at improving the care quality provided. Lastly, I can participate in the ACO as an Advanced Practice R.N to offer high-quality care – primary.
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How the ACOs impact me as a Health Care Provider and how this affects the Patient
As a health care professional, I am affected by ACOs in various ways. First, ACOs play a crucial role in enhancing my communication with other health care practitioners. According to Shortell et al. (2015), ACOs create improved communication all through the exchange. ACOs typically play a crucial role in promoting the exchanges of health data, which subsequently fosters effective communication among providers within the network. The process mentioned above facilitates the efficient exchange of data, and this, in turn, facilitates the effective coordination of care, which consequently minimizes service duplication. Secondly, participating in the ACO increases my eligibility for various cost advantages. Keerr, Kullgerm, and Saini (2015), in their study, indicate that one does not have to cater for all the expenses associated with improved patient care if one joins an ACO. The coordinated establishment of the network plays a crucial role in defraying the costs faced by all members because every individual work to upgrade or better the process of patient care. Furthermore, Pittman and Forest (2015) argue that joining an ACO fosters one's capacity to gain access to an extensive network of data aggregation, acquire an improved populace health control, and have a significant number of options to offer patients whenever they secure Medicare coverage. ACOs also offers one an opportunity to depend on other members for financial assistance. Thirdly, joining an ACO will play a crucial role in enhancing my ability to provide more comprehensive care to patients. Fourthly, ACOs underscore the concept of sharing; this conception can influence various decision-making approaches, thereby, impacting my independence during practice. Lastly, as a health care practitioner, I am able to drive or direct care plans as opposed to the traditional approach whereby insurance agencies directed care plans.
ACOs can also have significant impacts on patients within the system. First, ACOs can play a role in eliminating some of the expenses incurred by patients. Shortell et al. (2015) indicate that the implementation of the ACO model by health care providers can enhance the reduction of care costs for patients, thereby improving access to health care. Secondly, ACOs provide patients with an opportunity to receive more comprehensive care during hospital visits; this, in turn, plays a vital role in enhancing patient satisfaction. Thirdly, patients are likely to benefit from the significant reduction in medical errors due to the inclusion of health information technologies such as EHR by ACOs. Fourthly, the probability associated with the privacy breaches, particularly during the sharing of patient data by ACOs, is significantly high.
The Challenges we face and the Role of the Health Care Worker as a result of these Challenges
ACOs have been associated with numerous benefits for both health care practitioners and patients. However, this practice triggers various challenges in practice. One primary challenge with ACOs is the issue related to resource allocation. Shortell et al. (2015) argue that certain quality metrics are likely to receive a significant attention level and focus at the expense of other conditions not incorporated in the ACO requirements. This, therefore, triggers significant challenges in the attempt to balance the distribution of resources and the provision of quality care patients. Furthermore, some practitioners present complains regarding the infringement of their professional autonomy. Secondly, the concept of dual responsibility also poses a significant challenge for health care providers within the ACOs. According to DeCamp et al. (2014), patients are likely to lose trust in physicians who prioritize costs over their overall health. Thirdly, health care providers within the ACO experience significant challenges in managing competition. Professional ethics underscore the need to maintain effective relationships amid professionals. Shared accountability amid the health care providers can trigger harmful competition amid primary care providers and specialists or physicians and hospital leadership.
The challenges mentioned above are likely to impact the duty of health care professionals in various ways. First, professionals within the health care sector are likely to assume advocacy roles, as a result of the challenge associated with resource allocation. According to Kerr, Kullgren, and Saini (2017), health care professionals may assume a functional role in advocating for issues associated with the equal distribution of resources. Furthermore, health care practitioners may employ strategies that seek to defend their autonomy during practice. Providers may also attempt to protect the individual needs of patients irrespective of the quality metrics. Moreover, they may employ approaches that aim to educate patients on issues regarding healthcare and its associated costs. The strategy mentioned above will enhance the patients' capacity to comprehend the costs related to their conditions; this will, in turn, promote a healthy relationship among patients and providers.
In conclusion, ACOs play a crucial role in enhancing the quality, experience, and value of patient care by modifying the processes employed during the delivery of health care and its associated costs. The appropriate implementation of the ACO conceptualization can enhance the adoption of synchronized care aimed at uniting hospitals and health care providers from different practice fields to ensure the effective collaboration among stakeholders to promote the achievability of the overall needs of patients. ACOs, therefore, ought to work relentlessly to better care quality, foster better family and patient encounters, and recognize areas that necessitate the improvement of value.
References
DeCamp, M., Farber, N. J., Torke, A. M., George, M., Berger, Z., Keirns, C. C., & Kaldjian, L. C. (2014). Ethical challenges for accountable care organizations: a structured review. Journal of General Internal Medicine , 29 (10), 1392-1399.
Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review , 76 (3), 255-290.
Kerr, E. A., Kullgren, J. T., & Saini, S. D. (2017). Choosing wisely: how to fulfill the promise in the next five years. Health Affairs , 36 (11), 2012-2018.
McClellan, M., Udayakumar, K., Thoumi, A., Gonzalez-Smith, J., Kadakia, K., Kurek, N., ... & Darzi, A. W. (2017). Improving care and lowering costs: evidence and lessons from a global analysis of accountable care reforms. Health Affairs , 36 (11), 1920-1927.
Pittman, P., & Forrest, E. (2015). The changing roles of registered nurses in Pioneer Accountable Care Organizations. Nursing Outlook , 63 (5), 554-565.
Shortell, S. M., Colla, C. H., Lewis, V. A., Fisher, E., Kessell, E., & Ramsay, P. (2015). Accountable care organizations: The national landscape. Journal of Health Politics, Policy, and Law , 40 (4), 647-668.
