In their infancy, ACOs come in all shapes and sizes
As healthcare reform takes root and accountable care organizations (ACOs) make their mark on the map, the healthcare landscape grows more complex, according to a January report from CSC.
Most prominent accountable care initiative is the federal government’s Medicare shared savings program, but a number of state governments and commercial health plans are also turning to accountable care to achieve savings and improved quality, Jane Metzger, a researcher for the Falls Church, Va.-based IT services firm, said in the report summary. “As a result, accountable care is much more than simple a new model for Medicare. It is an emerging payment model, and many providers are already finding that more and more of their reimbursement is coming from multiple accountable care contracts.”
While accountable care continues to grow, there are broad variances in the specific structures of individual ACOs. For instance, there are several different payment models that ACOs can adopt, Metzger wrote. They may pay for performance, issue bundled payments, issue capitated payments, share savings, share risk or adopt a mixed reimbursement model.
Despite differences from one reimbursement model to the next, each offers incentives to coordinate care for the purpose of reducing costs by, for instance, reducing hospital readmissions, which may force a healthcare team to focus more on a patient’s return to home than they had in the past. However, these coordinated care efforts can also be modeled much differently from one to another, according to Metzger. One ACO may choose to coordinate care through a primary care provider, another may choose to do so through staff dedicated to care coordination and another may forego care managers for shared responsibility across the entire healthcare team. To make matters more complex, a single patient could receive treatment from providers belonging to separate ACOs.
Despite the complexity of the ACO landscape and mixed results to this point on their ability to reduce costs, coordinated care lowers the risk that a patient encounter gaps in their treatment and increases their likelihood of receiving the right care at the right care. As health IT functionalities improve and users become more proficient with the devices, it’s also likely that increased documentation will improve outcomes, according to Metzger.
“For providers attempting to collaborate in providing accountable care for a population of patients, it creates operational integration that helps overcome fragmentation,” Metzger concluded. “Especially during hand-offs, it rationalizes and structures roles and responsibilities. Applied more broadly, care coordination can not only make continuity of care efficient, but also remove many current gaps in care that contribute to poor outcomes and high cost.”
To read the complete report, visit the CSC website.