Accountable Care Organization as Described in the Patient Protection and Affordable Care Act of 2010
Since ACOs are concerned with transforming non-financial and financial incentives as far as health care providers are concerned, it is anticipated that health care costs will gradually reduce. If ACOs use some of the provisions that the 2010 Act advocates for, there will be considerable financial incentives. This will ensure the promotion of ACOs within Medicare. Through this, it is anticipated that there will be an achievement of some cost savings (McClellan et al, 2010).
On March 31st, 2011, the DHHS (Department of Health and Human Services) came up with the first set of guidelines. These were to be used in initiating Accountable Care Organizations according to the MSSP (Medicare Shared Savings Program). This was under the PPACA’s 3022 section. According to these guidelines, the essential steps which are required by voluntary groups are stipulated. The stated voluntary groups have to comply with these guidelines to participate in the ACOs (McClellan et al, 2010). According to the 3022 section, the Patient Protection and Affordable Act gives the authority of CMS (Center for Medicare and Medicaid Services) to come up with the MSSP. This permits the initiation of ACOs’ contracts. Through the MSSP, efficient, timely, and quality health care delivery will be guaranteed. The MSSP safeguard that the ACOs are a mandatory option as far as the Medicare is concerned.
The MSSP is recognized as a 3-year program. In this regard, ACOs have a role in the general care, cost, and quality of the beneficiaries under the group. ACOs are responsible for more than five thousand beneficiaries. The key provider has a role of involving adequate primary care physicians who should serve the beneficiary population (Fisher et al, 2009). The ACO has a role in defining the processes that enhance patient involvement as well as evidence-based medicine. Another role is evaluating and monitoring measures for cost and quality. In addition, the ACO should coordinate care and adhere to the criteria for patient-centeredness. Before the implementation of the MSSP, the ACO should come up with opposite supremacy and lawful frameworks, effective systems for management, clinical plans, and an appropriate delivery system for the common savings. The Act allows ACOs to engage with other ACO professionals during networking sessions and group practice and joint venture arrangements, and partnerships.
According to the Act, the ACOs are entirely responsible for offering affordable, quality, and general healthcare to all the beneficiaries assigned to it. The ACO has to agree with the Secretary to be able to involve itself in the program for three years (McClellan et al, 2010). Moreover, the Act commands that there should be a lawful arrangement in the ACO to permit it to dispense and get payments. According to Berwick (2011), the ACOs should be responsible for evaluating the health needs of the beneficiaries entitled to it, and taking measures to ensure their well-being. It should also participate in Medicare programs. The ACOs should engage in the administration and clinical systems, which involve management and leadership.
Efforts to Establish ACOs around the USA
The term ACO was utilized first by Elliot Fisher in 2006. He was then the director of the Center for Health Policy Research at the Dartmouth Medical School. The term was used during a public meeting discussion of the Medicare Payment Advisory Commission. Consequently, the term became generally accepted in the year 2009. This is the period when the term Accountable Care Organization was used in the Patient Protection and Affordable Care Act. Irrespective of the fact that the term was developed in 2006, it is similar to the definition given to HMO. The prominence of HMO was widespread during the 1970s.
Similar to HMOs, ACOs are the entities that have full responsibility for offering whole and quality health care services to the beneficiaries. For the previous eight months, the United States of America has experienced considerable growth in healthcare institutions, which are using accountable care payment plans. Irrespective of the huge difference in the models utilized, this growth is an indication that health care is beyond offering services and receiving payment for the services offered. By May 2012, Leavitt Partners had tracked the operation of two hundred and twenty-one ACOs through the use of private and public sources. There is a higher rate of ACOs in massive population centers; ACOs have expanded to forty-five diverse countries.
The model of payment and care coordination in the ACOs is different depending on the organization. This greatly contributes to the initiatives, the organizations which involve themselves with ACOs. In September 2011, a report on the detailed growth of Accountable Care Organizations in the USA was published. There is a vast number of entities that are involved in and engaging with ACOs. This number keeps increasing daily. There are various sources from where the information on ACOs can be obtained. These include public records, interviews, conferences, news releases, articles, or press.
There is an immense expansion in the types and number of Accountable Care Organizations (Berwick, 2011). Presently, there are two hundred and twenty-one ACOs in forty-five states. There has been continuous progress in the number of ACOs. Moreover, various sorts and numerous models, through which peril allocation can be achieved, are being verified. Particularly, there has been more growth of ACOs in massive metropolitan areas. There is also a tendency for multiple ACOs competing within a similar market. The hospital systems are the key and main backers for ACOs. However, physician groups have an increasingly greater responsibility. There is an increasing need to assess the effectiveness of the various ACOs. A greater number of organizations have a focus on improving outcomes for ACOs at reduced prices. It is worth noting that Medicare ACOs are particularly restricted to the private models. The private model’s accomplishment will forecast Medicare ACOs’ upcoming. There is an extreme competition of ACOs in Boston and Southern California.
References
Berwick, D.M. (2011). Making good on ACOs’ promise – the final rule for the Medicare Shared Savings Program. N Engl J Med, 365, 1753-1756
Fisher, E., et al. (2009). Fostering Accountable Health Care: Moving Forward in Medicare. Health Affairs, 28(2), 219-231.
McClellan, M., et al. (2010). A National Strategy to put Accountable Care into Practice. Health Affairs, 29(5), 982-990.
McClellan, M., McKethan, A.N., Lewis, J. L., Roski, J., &Fisher, E. S. (2010). Accountable Care Organizations. A National Strategy to Put Accountable Care Into Practice,29(5), 982- 990.