Introduction
The Affordable Care Act (ACA) introduced the concept of accountability to increase the value of patients in the healthcare system. The most important goal is to reach their distinctive features, which enable value-based results driven by leveraging physicians and hospitals to work collaboratively to deliver quality patient care (Lewis et al., 2019). The reward is available to healthcare providers based on their ability to achieve the anticipated results. However, such initiatives as Bundled Payment Care and Affordable Care Organizations have emphasized the importance of reducing expensive and unnecessary services to make patient care more cost-effective. Therefore, accountability in the healthcare sector enhances physician-patient trust, enables organizations to provide higher-quality care, and minimizes resource misuse.
Accountable Care Organizations
Accountable Care Organizations (ACO) play a critical role in ensuring that Medicare beneficiaries receive high-quality healthcare. According to Lewis et al. (2019), an ACO is a group of healthcare vendors and practitioners who work together to offer quality care to Medicare beneficiaries through the coordination of resources. The primary objective is to provide high-quality, collaborative treatment and care for patients. All of the healthcare professionals involved in the patient’s care will work together to ensure that everything they do is geared toward the patient’s health (Lewis et al., 2019). By coordinating care, increasing the meaningful use of health information technology (HIT), and directly involving patients and their families as decision-making partners, ACOs seek to promote the quality of care patients receive. As a result, ACO ensures that healthcare providers work together to offer quality healthcare services to patients.
The Difference Between ACO and Health Maintenance Organization
ACO and Health Maintenance Organizations (HMOs) differ in various ways. Firstly, based on purpose, the main goal of an HMO is to offer preventative health services to people at a low cost, which can be beneficial to those who require a health plan but cannot otherwise afford one (Chernew, 2019). On the other hand, ACO’s goal is to leverage better and more efficient healthcare processes for the good of the patient in order to minimize long-term costs. The ACO tries to get people to get help before they have a problem, stay on their medication therapies, and make lifestyle modifications that make them healthier and less likely to have costly problems. For Medicare patients, an ACO wants to help doctors develop a healthcare system that is less expensive and more effective at the same time (Chernew, 2019). Thus, the variation between ACO and HMO is the approach taken to make sure that patients receive quality care.
Moreover, the main difference between ACOs and HMOs is that ACOs have financial incentives and payments based on risk transfer and success. On the other hand, HMOs do not have a way to measure quality and improve care (Chernew, 2019). Another difference is that ACOs pay doctors for their patients’ quality of care while reducing wasteful spending. This is because they do not care about making money but about taking care of a patient. However, the HMOs did not care about the quality of care they give to their patients (Chernew, 2019). In addition, HMOs offer medical care to groups of people who have agreed to join their groups. ACOs, on the other hand, offer care to the people who want it without having them join.
The Role of Health Information Technology
Health information technology (HIT) is crucial in delivering healthcare services and the development of new healthcare models. It provides avenues for healthcare providers to change their care models (Vest et al., 2019). They aid in the reduction of medical mistakes when multiple healthcare professionals provide care to an individual without collaboration. In addition, it enables the exchange of critical patient information, which determines the type of care and medication provided. For instance, the use of HIT in hospitals is crucial because it adds to patient-centered care by enhancing contact between a healthcare professional and a patient via text, email, and other forms of communication. The usage of HIT also enhances patient-provider interaction and coordination, resulting in increased patient safety (Vest et al., 2019). Therefore, HIT is among the aspects that support the provision of quality healthcare services.
The Benefit of Hospitals Partnering with Primary Care Providers
There is a range of advantages to working together with hospitals and primary care providers. Firstly, healthcare facilities work with primary care providers to improve patient care and safety, which helps close the gaps caused by Medicaid expansion and other factors (Delaney, 2018). Secondly, partnerships between hospitals and primary care providers lead to lower costs and fewer readmissions, which is good for patients and improves care. Thirdly, the use of electronic health records (EHRs) helps healthcare facilities and caregivers work together, which leads to better communication and, as a result, more efficient and quality care for patients (Delaney, 2018). As a result, a partnership between providers and hospitals is integral to attaining healthcare objectives.
Bundling Payments
Bundling payments helps control and manage healthcare costs and keep healthcare costs down. In the U.S., when payments were bundled, the quality of care was better, leading to lower medical costs and other costs caused by poor service (Bosco et al., 2018). Then, bundling payments helps keep healthcare costs down, which is good for everyone. Another way bundling payments could lower health costs is by saving money on joint replacements because the treatment for the different health issues covered in this payment could have required patients to alter their behavior (Bosco et al., 2018). As a result, saving money as a practice in this technique reduces healthcare costs. In addition, this payment method helps contain the unnecessary costs that may be incurred in healthcare. Therefore, bundling payments plays an important role in reducing the cost of care in the system.
How to Pay for Performance to Improve Quality Care
Pay for performance (P4P) is an emerging health strategy to improve the quality and the use of essential healthcare services. P4P is a financial incentive-based strategy for improving healthcare quality (Oxholm et al., 2021). It aims to improve compliance with best practices by offering financial assistance to healthcare providers. Adherence to clinical guidelines enhances clinical outcomes and quality of care. Another way P4P can enhance the quality of care is when penalties are given to healthcare providers if they do not give good service to patients (Oxholm et al., 2021). For example, if a health professional gives a patient the wrong medicine and the person’s health issue gets worse, the practitioner responsible has to pay for all the medical costs. The penalties will make service delivery more effective, which will lead to better care.
Value-Based Purchasing Program
A value-based purchasing initiative run by the Centers for Medicare and Medicaid Services pays critical care hospitals additional revenue if they offer quality care to Medicare patients. These rewards depend on how healthcare facilities improve the patient’s outcome during hospitalization (Beauvais et al., 2020). It also assesses how closely the facility adheres to and implements best clinical practices when providing healthcare. The initiative’s final consideration is the quality of healthcare provided by the facility. It also focuses the payment on the amount of advancement on every performance measurement. The primary aim of value-based purchasing is to help patients have better and more advanced clinical outcomes while also improving the quality of care they get while in the hospital.
Value-Based Reimbursement
The people who benefit the most from value-based reimbursement are patients. Value-based reimbursement spends more time working with patients to help them avoid and prevent chronic diseases before they start (Beauvais et al., 2020). For example, a physician wants to make sure their patients get good health while having the right number of doctor visits and tests each year. People who work for health care providers get paid more if they help people avoid getting chronic diseases in the first place. With this intervention, patients are sure of getting quality healthcare services from providers (Beauvais et al., 2020). For example, if the providers and hospital facilities are rewarded for providing value, then patients stand to benefit through the provision of quality care. Therefore, because value-based payment models can aid in cost control and risk reduction, patients are the primary beneficiary.
How VBP Program Measures Hospital Performance
The VBP program uses the approved set of measures and dimensions known as quality domains to determine hospital performance. In 2018, the domain such as Patient and Caregiver-Centered Experience of Care and Care Coordination, safety, clinical care, efficiency, and cost reduction was set at 25% (Beauvais et al., 2020). Achieved and Improved scores are determined by the 50th percentile and the mean of the top decile. CMS uses these concepts to figure out how many points to give for each score (Beauvais et al., 2020). It also looks at the Attained and Improved performance scores and chooses the one with the best of both of them. To get a Performance Score, add up the best Achievement or Improvement points from each of the hospital’s measures, replicate each by some “weight,” and add the weighted marks. Therefore, VBP is an approach with a specific guideline and procedure used to measure hospital performance.
Conclusion
Accountability is a critical component of healthcare delivery because it helps in the provision of quality care. In the absence of accountability, it can be challenging to attain all the healthcare goals and initiatives. An accountable care organization (ACO) is a collaboration of healthcare suppliers and providers that coordinates their services in order to provide better care to patients. ACOs differ significantly from previous Health Maintenance Organizations (HMOs). For example, HMOs are insurance programs designed to provide healthcare services at a fixed cost to a specific population. When hospitals collaborate with primary care providers, they can address various issues, resulting in improved patient outcomes. Patients who receive high-quality care at an acute care facility are rewarded through a value-based purchasing program run by the Centers for Medicare and Medicaid Services.
References
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