Value-Based Care

Accountable Care Organizations: A Staple of Value-Based Care

How ACOs help health systems achieve the Triple Aim.


Prior to the rise of value-based care models, there was a certain level of trust among providers that high quality care was being delivered at the lowest possible cost for patients throughout their care journey. However, the widespread usage of health data told a much different story.

Patients’ care journeys lacked coordination and proper follow-up, leading to unnecessary testing, redundant treatments and - ultimately - avoidable readmissions.


 

Healthcare providers had no way to communicate with each other about their patient’s needs, so were unable to provide holistic, effective care throughout the continuum. As a result, there was an absence of responsibility for this ineffective and increasingly expensive care – and no consequences.

Enter: accountable care organizations.

“The Affordable Care Act (ACA) officially introduced ACOs to support the healthcare industry’s overarching goal of achieving the Triple Aim: improving care quality, enhancing the patient experience, and decreasing healthcare costs.” (Revcycleintelligence.com)

 

What is an Accountable Care Organization (ACO)?

“Accountable care organizations (ACOs) were created to push the industry away from fee-for-service and towards value-based care.” (Revcycleintelligence.com)

An ACO is a network of doctors, hospitals, and specialized providers or facilities that are aligned with a goal of coordinating high-quality care. In other words, this network serves as a protected care continuum for patients – ensuring they receive the right care at the right time while avoiding unnecessary services and preventing medical errors.

As told by Revcycleintelligence.com, “ACOs promote higher care quality at lower costs while shifting risk to providers – making the model a staple of value-based care.”

This coordinated care effort shifts financial accountability, incentivizes holistic care across the care continuum, and in-turn, establishes value-based care as a sustainable healthcare model.

 

Shifting Financial Risk

“ACOs take value-based reimbursement to a new level by not only tying payments to quality, but also holding providers financially accountable for the care costs of their patient population.” (Revcycleintelligence.com)

ACOs shift financial accountability through agreements with Medicaid. They function by taking on the responsibility of the quality, cost, and experience that traditional fee-for-service Medicaid patients receive. In turn, ACOs are rewarded when they lower expenditures while meeting quality performance standards.

Therefore, “when an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.” (Revcycleintelligence.com)

 

Holistic Care Across the Continuum

To demonstrate success and value, it is essential that an ACO utilize healthcare data to support truly holistic care as they follow their patients throughout the care continuum.

This is why, according to a Quest Diagnostics survey, it is clear that technology – the use of an EHR – is the number one tool that providers needed to succeed in value-based care. This sharing of information is paramount. Partnering with an ACO allows health systems to gain insight and access technology, data, and clinical capabilities from their peers.

Acting on a patient’s health data allows health systems to provide the most efficient and cost effective care, while seamlessly moving the patient through the care continuum, thus elevating the patient experience.

 

Amplifying the Significance of Value-Based Care

The impact, adoption, and outlook of value-based care continues to grow alongside the formation of ACOs.

“Since the Affordable Care Act, providers and payers have formed over 1,000 ACOs covering about 32.7 million patients across the country. Those numbers are likely to increase as value-based reimbursement participation eclipses fee-for-service.” (Revcycleintelligence.com)

As a result - in contrast to fee-for-service models that may deter physicians from delivering holistic, quality care - ACOs establish a more sustainable value-based health system that is focused on overall value and accountability.

 

 

Hear about healthcare waste from healthcare veterans.

Hear from healthcare veterans Blain Claypool - Chief Operating Officer, and Dr. Reuben Tovar - Chief Medical Officer, of HNI Healthcare, as they walk through their experience navigating value-based care, risk-based arrangements, and alternate payment models, and how they got buy-in from their hospital, providers, and colleagues.

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