Accountable Care Organizations were first started to support the improvement of payment and delivery systems in the US Health Care process. The reasoning came about because no single stakeholder; doctors, financial providers, or hospitals, took personal responsibility for the healthcare provided to patients. The ACOs also aim to lower the cost of care to patients. This is achieved through incentives given to ACOs when they achieve lower costs per patient. According to Berwick (2011), the Centers for Medicare and Medicaid Services define ACO’s as groups made up of healthcare providers, physicians and hospitals that join forces to provide synchronized high-quality care to patient is the Medicare scheme.
The ACOs are judged according to 4 major parameters, patient experience, patient safety and the coordination of care for the patient, preventive health and the care of at-risk populations (Kagan, 2018). The Electronic Health Record collects and collates data in these categories, ranking the service providers against this criterion. According to CMS (2019), these reviews keep ACOs aware of the need to do well and high performance results in increased reimbursement rates. (Kagan, 2018) ACOs come with positives and negatives, the positives largely center around the provision of better care to patients and lower costs. McWilliams et, al. (2016) who studied the performance of ACOs saw results of lower costs of $3 per patient in the year 2012, however there were no such savings the next year. They also concluded that hospital- integrated groups had less savings than independent care groups. Mcliams et al (2016) points out that research into patient care also shows results of a varying nature. Patients acknowledged that there was improved access to physicians and that their physicians had information about specialty care. However, they reported little change in their interaction with physicians. This was only different for those in the category of multiple chronic conditions. These patients rated both access (86-98 percentile) and overall rating (82 – 96 percentile) higher.
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ACOs are faced with challenges that include, a payment model that does not support the core objectives, no definition of the number of medical staffs to have, technological issues and a lack of physician led management. The payment model that encourages the rewards for volume over quality negate the earlier objective of the system. Without the ability to focus on quality the ACO is unable to fulfill a core mandate. The medical facilities especially hospitals can in some cases have higher numbers of staff than required (Kagan, 2018). This results in the more unnecessary care and lower productivity. The lack of integrated technology platform means that patient data is harder to share and access. This results in the physicians not providing coordinated patient care. Finally, physician leaders are key to ensure growth in operational performance. This is because only they and not administrators understand how to bring about greater gains in the care of patients. Dr. Pearl (2014) states that the negatives also associated with ACOs have largely to do with the worry that the consolidation of service providers may lead to higher costs because they have more power to negotiate with insurers. This has not been proven by any research.
Regarding, the impact of ACOs on health care organizations it has been seen that organizations that had performed well before ACO participation continued to do so while those that performed poorly also continued to do so. The gains were noted largely in areas of nurse and doctor communication and patient experience. This was largely prevalent in organizations in the Pioneer ACOs and the Shared Savings Programs ACOs (Zhang et al., 2019). In a nutshell, the body of literature about ACOs is partially limited due to their existence for only under a decade.
References
Berwick, D. M. (2011). Launching accountable care organizations—the proposed rule for the Medicare Shared Savings Program. New England Journal of Medicine, 364(16), e32.
Centers for Medicare and Medicaid Services, (2019). Accountable Care Organizations retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
Diana, M. L., Zhang, Y., Yeager, V. A., Stoecker, C., & Counts, C. R. (2019). The impact of accountable care organization participation on hospital patient experience. Health care management review, 44(2), 148-158.
Dr. Pearl, R. (2014) The 4 Biggest Obstacles ACOs Face. Forbes Magazine retrieved from https://www.forbes.com/sites/robertpearl/2014/08/14/the-4-biggest-obstacles-acos-face/#6ec96f9965f2
Kagan, J. (2018). Accountable Care Organizations Investopedia retrieved from https://www.investopedia.com/terms/a/accountable-care-organizations.asp
McWilliams, J. M., Hatfield, L. A., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine , 374 (24), 2357-2366.
