ACCOUNTABLE CARE ORGANIZATIONS (ACOs)

ACCOUNTABLE CARE ORGANIZATIONS(ACOs)Safiah MamoonHTM 520

INTRODUCTIONU.S. healthcare sector very large with fragmented careHigh spending for poor outcomesCare not coordinatedProviders reimbursed for services regardless of qualityAccording to the IOM, care needs to be:SafeEffectiveEfficientEquitableTimely Patient-centeredACOs can be the solution

WHAT IS AN ACO ?

Set of providers jointly held accountable for achieving measured quality improvements reductions in the rate of spending growthProvides coordinated, patient-centric services across continuum of care in designated populationComprised ofprimary care physiciansSpecialistshospitalspost-acute care facilitieshealth insurance plansOther

ACA and ACO

ACA of 2010 required Medicare to start utilizing ACOs by 2012To participate in the Medicare Shared Savings Program (MSSP), ACO mustEnroll 5000 Medicare beneficiaries Participate in the MSSP for a minimum of 3 yearsShare in any cost savings that arise from quality improvements and enhanced efficiency

ACO and Meaningful Use (MU)

ACO need to show improved performance on 65 clinical measures in 3-year period26 of 65 requirements also MU Criteria captured by certified EHR systemStrong alignment between EHR incentive program and MSSPMU and HIEs will help ACO meet many of its objectivesACO AND MUMUImprove quality, safety, efficiency, and reduce health disparitiesEngage patients and familiesImprove care coordinationEnsure adequate privacy and security protections for personal health informationImprove population and public health.

MU goals

ACOs and Quantifiable DataDemonstrate evidence-based medical practiceDemonstrate patient engagementReport on quality and cost measuresDemonstrate improved outcomesDemonstrate cost-savingsValue-based reimbursementFinancial incentives

ACOs AND HIT

Organizations

AHIC

BENEFITS OF ACOs

Barriers and Challenges FinancialBusinessHIE-relatedStandards and CertificationPrivacy and SecurityCultural Legal

ACO MAP

FUTURE TRENDS

December, 2013500 ACOsExpected to double by end of 2014Commercial plans with ACOsAetna, Blue Cross Blue Shield, Cigna and Anthem/Wellpoint

EXPECTED TO GROWRememberWhat is an ACOJoint accountability measured quality improvements cost reductionpatient-centric coordinated servicesAcross continuum of careFinancial incentivesACA and ACOOrganizations and StandardsBenefitsBarriersFuture Trends