Respond by researching a solution to solve the proposed challenges your peers presented and describe why the solution you proposed should work. Also provide an explanation why your proposed solution has not already been adopted. Your reply posts should be 100 to 150 words, with a minimum of one supporting reference included for each Response below.
According to Barnes et al. (2014), accountable care organizations (ACOs) are organizations that assume financial responsibility and clinical accountability for the care provided to a defined patient population. These organizations are comprised of physicians, hospitals, and other healthcare facilities and work towards providing a higher quality of care to patients. ACO models aim to improve the experience of care, the health of populations, and reduce per capita costs (Barnes et al., 2014). Accountable care organizations are currently one of the largest payment and delivery reforms in the United States with over 700 ACO contracts in place covering nearly 23 million Americans (Colla et al., 2016). These organizations provide incentives to physicians to provide high quality care, which ultimately reduces healthcare expenditures as individuals are receiving better care. ACOs allow primary care physicians more flexibility to follow their patients more closely through follow up appointments. Closer monitoring of patients with chronic diseases prevents costly emergency department visits and preventable hospital readmissions.There are several challenges associated with the further implementation of accountable care organizations. According to Singer and Shortell (2011), there is possibility of overestimation of accountable care organization’s abilities. For instance, Singer and Shortell (2011) explain that there is an overestimation of an ACOs ability to access electronic health records as many physicians are not adequately trained and systems vary. The ability to report on the cost and quality metrics required for ACOs will be delayed, which also results in inadequate ability to report performance measures. Return rates on costs and quality will be significantly delayed as a result.
As there are both Medicare ACOs and private insurer ACOs, there are variations in both protocols and costs, which makes it difficult to implement ACO strategies. As a result of the variation between private and government funded ACOs, there is overestimation of the ability to implement standardized care management protocols (Singer & Shortell, 2011). Singer and Shortell (2011) state that for protocols to be efficient, clinicians must be involved in their development and protocols must allow for tailoring to individual patient needs. Variations in regulations of both Medicare and private insurer ACOs make it difficult to produce clinician guided protocol development.
ACOs are a payment model of managed care which emerged in the 1990s as an alternative to the fragmented and disconnected care that patients with chronic health conditions had experienced. Prior to ACOS patients with chronic health issues were being seen by multiple physicians who had no direct access to the patients’ information to coordinate decisions with one another (Dunlap et al. 2017).
There was a need for a more comprehensive physicians’ organization and that’s where ACOs come in. ACOs approach is to bring all providers, nurses, physicians, APRNs and all sectors of the continuum of care hospitals, clinics, skilled nursing homes, home care and other sites together to assume responsibility of all care rendered and to establish a patient population within the structures of the ACO model (Dunlap et al. 2017).
According to the CMS definition ACOs are a group of doctors, hospitals and other healthcare organizations who come together to coordinate services and provide quality care to patients they serve. Additionally, ACOs are network of service providers that agree to be held accountable for the cost and quality of care provided to patients and families (Dunlap et al. 2017).
Some of the challenges ACOs face include: a) ACOs provide incentives which ultimately can become a financial risk that may result in rationing or denying care to the population; b) ACOs collect data that capture volume reduction but more data should be submitted on quality improvement; c) ACOs need to create more incentives to engage health providers in disease prevention and health promotion; d) ACOs need to create more IT structures to establish patient-centered and integral care and facilitate access to patient’s information for all providers (Barnes et al. 2014).
ACOs need to rise to the challenge of monitoring, evaluating and reshaping payments and delivery system to improve patient’s experience of care and health. There is a pressure on ACOs to make large improvements in healthcare performance. ACOs should not be held to that standard. They are not exempt from financial issues and high healthcare expenditures. Social determinants of health will continue to impact healthcare costs. In order to achieve lasting improvements in healthcare costs the U.S health care system will need much more than just ACOs (Barnes et al. 2014).