Accountable Care Organization (ACO): High-impact Strategies - What You Need to Know: Definitions, Adoptions, Impact, Benefits, Maturity, Vendors

Kevin Roebuck

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An accountable care organization (ACO) is a type of payment and delivery reform model that seeks to tie provider reimbursements to 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 different payment models (capitation, fee-for-service with asymmetric or symmetric shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness, and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is ""an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.""

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In easy to read chapters, with extensive references and links to get you to know all there is to know about Accountable Care Organization (ACO) right away. A quick look inside:Accountable care organization, Department of Managed Health Care, Managed care, Step therapy, Association for Community Affiliated Plans, Capitation (healthcare), CareSource Management Group, Health maintenance organization, Healthcare Effectiveness Data and Information Set, Independent practice association, Integrated delivery system, Integrated Single Specialty Provider, Management services organization, Medicaid managed care, Medicare Advantage, Medicare Part D Cost Utilization Measures, New Century Infusion Solutions, Inc., Linda Peeno, Point of service plan, Preferred provider organization, Program of All-Inclusive Care for the Elderly...and Much, Much More!

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• Computers
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Informations

• Publié par: Emereo Publishing
• Date de parution: 24 octobre 2012
• Nombre de lectures: 0
• EAN13: 9781743336618
• Langue: English
• Poids de l'ouvrage: 1 Mo

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Contents

Articles Accountable care organization Department of Managed Health Care Managed care Step therapy

Association for Community Affiliated Plans Capitation (healthcare) CareSource Management Group Health maintenance organization Healthcare Effectiveness Data and Information Set Independent practice association Integrated delivery system Integrated Single Specialty Provider Management services organization Medicaid managed care Medicare Advantage Medicare Part D Cost Utilization Measures New Century Infusion Solutions, Inc. Linda Peeno Point of service plan Preferred provider organization Program of All-Inclusive Care for the Elderly

References Article Sources and Contributors Image Sources, Licenses and Contributors

Article Licenses License

1 4 5 10 11 14 16 18 22 27 28 28 29 30 31 35 36 39 40 41 43

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Accountable care organization

Accountable care organization

Health care in the United States

Public health care

Federal Employees Health Benefits Program Indian Health Service Medicaid Medicare Military Health System / TRICARE State Children's Health Insurance Program (SCHIP) Veterans Health Administration

Private health coverage

Health insurance in the United States Consumer-driven health care Flexible spending account (FSA) Health reimbursement account Health savings account High-deductible health plan (HDHP) Medical savings account Managed care Health maintenance organization (HMO) Preferred provider organization (PPO) Medical underwriting

Health care law and reform

Emergency Medical Treatment and Active Labor Act (1986) Health Insurance Portability and Accountability Act (1996) Medicare Prescription Drug, Improvement, and Modernization Act (2003) Patient Safety and Quality Improvement Act (2005) Patient Protection and Affordable Care Act (2010)

State level reform

Massachusetts health care reform Oregon Health Plan Vermont health care reform SustiNet (Connecticut)

Municipal health coverage

Fair Share Health Care Act (Maryland) Healthy Howard (Howard Co., Maryland) Healthy San Francisco

Anaccountable care organization(ACO) is a type of payment and delivery reform model that seeks to tie provider reimbursements to 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 different payment models (capitation, fee-for-service with asymmetric or symmetric shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness, and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is "an organization of health care providers that agrees to be accountable for the quality, cost, and overall care [1] of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it."

1

Accountable care organization

While the ACO model is designed to be flexible, Dr. Mark McClellan, Dr. Elliott Fisher and others defined three core principles for all ACOs: 1) Provider-led organizations with a strong base of primary care that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients; 2) Payments linked to quality improvements that also reduce overall costs; and, 3) Reliable and progressively more sophisticated performance measurement, to support improvement and provide confidence that savings are achieved [2] through improvements in care. [3] The ACO-model builds on the Medicare Physician Group Practice Demonstration and the Medicare Health Care [4] Quality Demonstration , established by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. Kaiser Permanente and HealthCare Partners Medical Group are two notable examples of successful ACOs. While ACOs have become increasingly more common in the last few years, a recent study by the Medical Group Management Association (MGMA) has shown that the implementation of ACOs is one of the toughest challenges [5] facing the MGMA members today.

ACOs in the Affordable Care Act

Section 3022 of the Patient Protection and Affordable Care Act (ACA) creates the Medicare Shared Savings [1] [6] program, allowing ACOs to contract with Medicare by January 2012. According to the ACA, the Medicare Shared Savings program, "promotes accountability for a patient population and coordinates items and services under part A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery". Section 3022 outlines the following requirements for ACOs:  The ACO shall be willing to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it  The ACO shall enter into an agreement with the Secretary to participate in the program for not less than a 3-year period  The ACO shall have a formal legal structure that would allow the organization to receive and distribute payments for shared savings to participating providers of services and suppliers  The ACO shall include primary care ACO professionals that are sufficient for the number of Medicare fee-for-service beneficiaries assigned to the ACO under subsection  At a minimum, the ACO shall have at least 5,000 such beneficiaries assigned to it in order to be eligible to participate in the ACO program  The ACO shall provide the Secretary with such information regarding ACO professionals participating in the ACO as the Secretary determines necessary to support the assignment of Medicare fee-for-service beneficiaries to an ACO, the implementation of quality and other reporting requirements under paragraph (3), and the determination of payments for shared savings under subsection (d)(2)  The ACO shall have in place a leadership and management structure that includes clinical and administrative systems  The ACO shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies  The ACO shall demonstrate to the Secretary that it meets patient-centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans [7]  The ACO participant cannot participate in other Medicare shared savings programs  The ACO entity is responsible for distributing savings to participating entities  The ACO must have a process for evaluating the health needs of the population it serves CMS' Notice of Proposed Rule was released March 31, 2011 for the Medicare Shared Savings program and the [8] Comment period closed June 6, 2011.

2