Friday, July 01, 2011
“On March 31, 2011, the Department of Health and Human Services (HHS) released proposed new rules to help doctors, hospitals, and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).”
“Under the proposed rule, an ACO refers to a group of providers … that will work together to coordinate care for the patients they serve …. The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries. … a patient-centered organization where the patient and providers are true partners in care decisions.”
Last year’s Patient Protection and Affordable Care Act (PPACA) provides for a number of policies to assist providers in improving patient safety and quality of care, hopefully making health care affordable. Through the Medicare Shared Savings Program, ACO’s with lower health care cost, and achieving certain performance standards, will be financially rewarded. The goal is to create incentives for providers to work together in a coordinated manner across all health care channels to provide quality and affordable health care to Medicare beneficiaries. If successful, this model could be adopted by other public plans as well as private insurers and employer’s sponsored health care plans.
Some of concepts of an Accountable Care Organization sound very similar to those of the initial attributes of the early Health Maintenance Organizations. Both organizations strive to deliver well coordinated, quality care in a cost effective manner. Philip Betbeze, writing for HealthLeaders Media, in a November 15, 2010 article was quoted as saying “standardized care is better care, and that hospitals, physician practices, rehab centers …will deliver better care if it is coordinated, and if financial penalties or rewards accrue to those organizations producing better outcomes”. Thirty years earlier, Dustin Mackie and Robert Biblo writing in the American Journal of Law and Medicine in 1980, stated that, “the health maintenance organization (HMO), whose primary goal is to provide quality medical service in a cost efficient manner”.
ACO's and HMO's Both organizations have the capability to organize themselves into legal entities to provide end to end health care for individuals as well for public and private health care plans. Such organizational structures include the well known “(IPAs) while others may prefer a physician-hospital organization (PHO)”. Consider that both organizations expose themselves to financial risk by accepting the “accountability” for delivering total patient care. Likewise, HMO’s agree to accept capitation in return for meeting the HMO member’s medical needs.
The initial HMO concept of a “gate keeper” made perfect business sense up to the point when members wanted more personal choice in the selection of their primary care physician, pharmacy, hospital or physical therapist. Forced to receive their medical care through a single sources, large numbers of employees, and their health care plan sponsoring employers abandoned HMO’s for the semblance of managed care in the form of PPO’s.
Only time will tell the fate of Accountable Care Organizations.
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