...Accountable Care Organizations May 5, 2012 Accountable Care Organizations represent a strategy outlined within the Affordable Health Care Act to control costs and improve quality. They require partnerships between providers, hospitals, and communities. There are challenges in health systems where private practice is the predominant practice structure. Key issues and challenges to an effective ACO are cost reduction and utilization management, business model shifts, risk sharing and population management, consolidation, a changing role of IT and value of data, physician integration, clinical process improvement, and consumerism and the patient. How to reduce cost is a question that has been pursued, and it needs to be looked at, as well as utilization of management. Does this mean that homes for critically ill children or a hospital that cares only for transplant patients is becoming the future of health care in the USA? Why Accountable Care Organizations? No one will dispute the high cost of health care in the United States. Critics often say that it is the result of how health care providers are paid. They claim that—with a fee for each service— this results in increased and wasteful spending. Critics say that this system rewards providers just for doing more procedures, rather than for providing efficient and high-quality care (Matthews, 2012). In an effort to handle this problem, the United States Government has passed legislation: The Affordable Care...
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...Melody Song HCA 450: Special Topics April 16, 2015 ACO and Bundled Payments Accountable care organizations (ACOs) were proposed in the Affordable Care Act as a measure to slow rising healthcare costs and improve quality in the traditional healthcare organization. ACOs seek to tie provider pay with quality outcomes and reduce total cost of care by increasing integration and reducing fragmentation. Within an ACO, a group of coordinated health care providers deliver and care across the full continuum to a group or population of patients. The ACA introduces and encourages use of ACOs by establishing the Medicare Shared Savings Program (SSP) for Medicare Reimbursement through the Centers for Medicare and Medicaid Services (CMS). Under the SSP, providers that participate in an ACO continue to receive traditional Medicare fee-for-service payments but may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. Therefore, “if an ACO succeeds in both delivering high-quality care and reducing the cost of that care to a level below what would otherwise have been expected, it will share in the Medicare savings it achieves.” ACOs are however, held to high standards and must meet several quality-performance standards to ensure their patients meet preventative and chronic health needs. The Medicare SSP focuses on achieving the Triple-Aim of better care experience for individuals, better health for populations, and lower per capita costs. While...
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...HEALTH AND HUMAN SERVICES: Centers for Medicare & Medicaid Services (CMS), HHS. The reason that I chose this regulation is because the provisions made to the Affordable Care Act will not only affect everyone before me but my friends and family after me as well. As of now, this ruling doesn’t affect me due to the fact that I am not a recipient of Medicare as of yet. 2. The regulation I chose, CMS-2010-0259 implements the final ruling of section 3022 of the Affordable Care Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. Under these provisions, providers of services and suppliers can continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, and be eligible for additional payments if they meet specified quality and savings requirements. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES, It is of my concern that the Shared Savings Program has similar characteristics to some forms of managed care where it is possible to achieve savings through inappropriate reductions in patient care. As with some managed care approaches, the Shared Savings program essentially transfers the responsibility for health care away from the patient, which is not as effective as more consumer-driven approaches. It is my opinion that the Shared Savings Program may not be in the best interest...
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...the New Medicare Payment Reform Target There has been much addressed about the Affordable Health Care Act (ACA). The law was passed to allow preventive care more accessible and affordable to the population. Today, most health care payments are made on a fee-for-service basis, which rewards overuse, promotes waste and inefficiency, and pays little attention to accountability for quality of care. The ACA offered the opportunity to test alternative payment models that pay health providers based on the value of care rather than volume. This change in the law of health care allows payments to healthcare providers on the quality of care, rather than the quantity of care. The models implemented under the ACA rewards health providers who can improve patient outcomes and reduce costs through a variety of approaches, including shared savings, financial risk, and enhanced payments for care coordination and service integration. Some key examples of these new models are patient-centered medical homes, bundled payments, and accountable care organizations. These alternative models are close to meeting the goals of improved quality and reduced cost. The models are also looking to have some promise when it comes to meeting the goal of requiring providers to reduce hospital readmissions and rewarding meaningful use of health information technology (Zeke Emanuel, 2015). Today is the crucial time to apply these new payment models on a more widespread to improve American health care. This...
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...Managed Care Describe the beginning of ACO In 2011, the US Department of Health and Human Resources has proposed the guidelines for Accountable Care Organisation (ACO) under the Medicare shared saving Program. The Patient Protection and Affordable Act authorises CMS to create the MSSP that help doctors, hospitals and other health care provider in coordinating care for Medicare patients through ACO. An ACO is a network of group of provider and suppliers who work together to provide high quality care for the Medicare Fee-for service patients they serve. The ACO model was developed by Fisher, that private hospitals and organisation can be grouped into virtual organisation that is accountable for cost and quality of the range of care services delivered to Medicare patients. ACO work to provide high quality care to Medicare enrolees while simultaneously reducing health care costs. ACO is accountable to beneficiaries of Medicare for cost, quality and care. Till now eight private health insurance plans have entre with provider into ACO agreements that shares a payment risk model. Keeping the cost below a benchmark will make providers eligible for bonuses and incentives (Berenson & Burton, 2012). Objectives of ACO The main goal of ACO is to provide effective, accessible and coordinated care to patients it serves. ACO assures that care is delivers in a cultural component manner. The organisation aims to deliver seamless supreme quality care to beneficiaries of Medicare. In...
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...Accountable Care Organization is a healthcare organization characterized by a payment and care delivery mode. lt seeks to tie provider reimbursements to a quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients. The ACO may use a range of payment methods, (e.g. capitation, fee-or-service with an asymmetric or symmetric shared savings). The ACO is accountable to the patients and the 3rd party payer for quality, appropriateness, and efficiency of the health care provided. The Centers for Medicare and Medicaid Services (CMS), an ACO is considered an organization of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. This paper identifies the differences between HMO’s and ACO’s but also correlates the similarities between ACO’s and Patient Center Medical Home (PCMH). The ACO’s place a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. The success and challenges of ACO are identified and explored. By increasing care coordination, ACO’s can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization of acute care services...
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...Title Page Antoinette Price Health Reform Paper 2-17-16 Healthcare in America is changing at a rapid pace. The last time healthcare was moving this fast it was during the time that Medicare was launched. In this nation twice as much money per person is being spent on healthcare. The U.S. had the lowest score overall in quality, access, efficiency, equity, and healthy lives when in comparison to six other nations. There was also a lack of good chronic care management, care coordination, safety, and also the use of information technology. “The Supreme Court’s decision in June to largely uphold the constitutionality of the patient protection and affordable care act will mean the health reform implementation will proceed at a rapid pace” (healthaffairsblog). The congressional budget office plans to have about 23 million people insured by 2022. “New federal financial opportunities including the Medicare shared savings program, dual-eligible demonstrations pioneer accountable care organizations bundled payments, and numerous primary care initiatives are setting the stage to reward healthcare providers for patient care that is higher quality, more efficient, and more effective overall” (healthaffairsblog). In today’s society there is a fee-for-service payment model that rewards doctors and hospitals based on the service rather than the quality. Patients have little to no information about health cost and quality. There are many efforts to fix these problems so that each person...
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...Evolving Practice of Nursing and Patient Care Delivery Models The Speech Hello, my fello nurses. Thank you for being here at the Summit of Nursing Evolution. My name is Chhay Yann-Ly and I am a nurse. We are living in an era where the United States (US) health care system is going through tremendous changes and challenges, with sky-rocketing health care costs, fragmented and poor quality of care, high volume of aging population, and passage of the Patient Protection and Affordable Care Act (PPACA) in 2010. A summary of the PPACA is basically to improve the health care delivery system, expand coverage, and control cost (Democratics Senate Gov/Reform, n. d.). With these changes, comes the evolutionary nursing professional transformation process. This speech is a crash course on the evolving practice of nursing and patient care delivery models. The goal of this speech is to discuss the continuity or continuum of care in relation to accountable care organizations, medical homes, and nurse-managed clinics health care models. Since nursing is the backbone of health care, all of these care delivery models require a robust nursing contribution for success (American Nurses Association (ANA), 2010). The first model is the accountable care organizations (ACO). ACOs is a “shared savings” with Medicare (part A & B). The ACO, according to the ANA (2010), is “a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility...
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...Shared Decision Making Shared Decision Making Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences. Decision aids or shared decision making programs have been developed as adjuncts to counseling from practitioners. The decision aid I chose from the Ottawa list of patient decision aids is “Depression: Should I take an antidepressant?” I decided to use this aid due to my experience in clinical this semester and feel it will be very helpful in assisting my patients make the best decision. While in clinical, I have noticed most of the patients being treated are taking antidepressants. We also have many patients inquire about taking antidepressant medication. Many patients interested in antidepressants do not understand how they work, possible side effects, and question if once on antidepressants, will they have to stay on antidepressants. What I appreciate most about this tool is that it is a step-by-step process allowing the patient to rate their feelings regarding depression and its treatments based on what the practitioner has informed them. At the end, the patient takes a quiz about what they have learned and has an opportunity ask more questions and voice concerns. Through shared decision making, clinicians can help patients understand the importance of their values and preferences...
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...improving Quality and Value in the U.S. Health Care System August 2009 Preamble The Bipartisan Policy Center (BPC) is a public policy advocacy organization founded by former U.S. Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. Its mission is to develop and promote solutions that can attract the public support and political momentum to achieve real progress. The BPC acts as an incubator for policy efforts that engage top political figures, advocates, academics, and business leaders in the art of principled compromise. This report is part of a series commissioned by the BPC to advance the substantive work of the Leaders’ Project on the State of American Health Care. It is intended to explore policy trade-offs and analyze the major decisions involved in improving health care delivery, and discuss them in the broader context of health reform. It does not necessarily reflect the views or opinions of Senators Baker, Daschle, and Dole or the BPC’s Board of Directors. The Leaders’ Project was launched in March 2008. Co-Directed by Mark B. McClellan and Chris Jennings, its mission is (1) to create a bipartisan plan for health reform that can be used to transform the U.S. health care system, and (2) to demonstrate that health reform is an achievable political reality. Over the course of the project, Senators Baker, Daschle, and Dole hosted public policy forums across the country, and orchestrated a targeted outreach campaign to...
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...Accountable Care Organizations: Key to Transforming Healthcare? The Talia Goldsmith, MHA Candidate 2011 Suffolk University Sawyer Business School HLTH 890AE: Healthcare Strategic Management Professor Richard H. Gregg, M.A., M.B.A. April 28, 2011 Table of Contents Objective .....................................................................................................................................3 Introduction ..............................................................................................................................3 Overview of ACOs as a Mandate and an Opportunity for Healthcare Organizations............................................................................................................................4 Examples of Missions, Visions, Values and Goals for ACOs........................................6 Mission ................................................................................................................................................. 6 Vision ....................
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...1994 1995 - 1999 2000 – 2004 2005 – 2009 2010 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation Early 1900's 1921 Women reformers persuade Congress to pass the Sheppard-Towner Act, which provided matching funds to states for prenatal and child health centers. Act expires in 1929 and is not reauthorized. (AALL) publishes a draft bill for compulsory health insurance and promotes campaigns in several states. A few states show interest, but fail to enact as U.S. enters into World War I. The idea draws initial support from the AMA, but by 1920 AMA reverses their position. 1927 Committee on the Costs of Medical Care forms to study the economic organization of medical care. Group is comprised of economists, physicians, public health specialists, and other major interest groups. Recommendations were completed by 1932. While some members would not support the recommendation for medical group practice, the majority did...
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...Funding the Rising Cost of U.S. Health Care. BY Vilando. HSA500 November 15, 2015 Funding the Rising Cost of U.S. Health Care. The United States continues to spend significantly more on health care than any country in the world, however, even though with this statistics the U.S has a lot of uninsured and does not have the healthiest citizens. In this paper, opinions will be given on the rising cost of overall’s health care’s impact in the U.S economy, followed by a comparising and contrasting factors impacted by the new health care act, pros and cons of using the private insurance rather than using the new health care reforms and the cost associated with its implementation and access to different groups will also be discussed. Rising Cost of Health Care The cost of the U.S health care system is higher than any country in the world. Its efficiency is also under serious scrutiny. If it was not an emergency, most physicians would require insurance verification. Therefore patients will be delayed of treatment. Moreover, the health care system in the U.S should be redesigned in terms of prevention rather than treatment with people who are already sick. Insurance should not go higher for people that have pre-existing conditions or with more health risk. Also the emergence and new discoveries in the field of...
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...Memo #1: Potential challenges on ACA Readmission Patient Safety Organization (PSO) was designated by the Affordable Care Act to assist Hospitals with relatively high readmission rates to reduce the number. Readmission is defined as an admission of a patient to the hospital within 30 days of the date of discharge. According to the Centers for Medicare & Medicaid Services (CMS), University Hospitals was on the list of high readmission rates, with an AMI of 21.8, HF of 26.6, and a total of 1328 of discharges. There are many resources available on reducing unnecessary hospital readmissions, for example, the ProjectRED, which “can reduce readmissions by integrating better communication among clinicians and patients and by instituting follow-ups after discharge” (CMS). However, one important approach was to improve the transition process in inpatient and outpatient care for UH. By setting up a detailed and enforceable action plan to improve continuity of care, UH should focus on the following aspects: the compliance of national safety goals and regulations, the quality of transition approaches, the follow-up of regular reexamine, etc. These are not only methods to avoid high readmission rates, but also techniques to improve patient satisfaction and to reduce unnecessary administrative costs. Furthermore, another plausible approach is to bring closer relationship between hospitals and patient families, since they are an important part of patient satisfaction. Pay-for-performance ...
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... United Health Care Contents Company Profile and History ........................................................................................................................ 3 Financial Statement Analysis ........................................................................................................................ 5 Major Acquisitions ...................................................................................................................................... 11 Major Litigations and Public News.............................................................................................................. 13 The Patient Protection and Affordable Care Act (PPACA) .......................................................................... 15 Strategies and Foresight ............................................................................................................................. 18 Bibliography ................................................................................................................................................ 20 2 United Health Care Company Profile and History UnitedHealth Group is one of the largest health care companies in the United States. UnitedHealth Group is currently made of three entities which are UnitedHealthcare, OPTUM, and Amil. UnitedHealthcare is the entity in responsibility of providing health benefits. OPTUM is the entity that offers health services. Amil is the health care entity doing business...
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