Accountable care organizations or ACOs ; the new structure in health management that the federal government has implemented has become the center of debate and discussion of this decade. This seven-page new health law has become one of the most complex and talked about issues in our lifetime. Any time a new or foreign idea gets implemented it automatically scores fear and worry for the parties involved. That’s exactly what ACO has done. In order to overcome the unknown that comes with new policies, it is our job to learn and familiarize ourselves with the laws and rules behind it, the advantages, and also disadvantages that might follow. In the case of ACOs, physicians, hospitals, insurers, and even patients have the sole responsibility to learn about the complex and foreign policy in order to stay up to date with the changes. ACOs structure needs to be understood clearly in order for health care professionals to follow it. The goals, concepts, and methods need to be studied and analyzed before blindly “following the herd”. The entire arrangement can be pared down to two goals; one goal is improved quality of patient care, but the other major goal is cost savings. It basically comes down to providing good quality care to Medicare beneficiaries at low costs and encouraging different health professionals to work together in order to provide superior care. When discussing ACOs, these following main points have to be addressed that explain briefly the main skeleton behind this new model of healthcare. The core elements are as follow:
-It’s a model that offers incentives to provide good care to Medicare beneficiaries at low cost.
-Combines cares of different specialties into one group thus making it easier for the patient to get second or more specialized opinion.
-The incentive is not just for Medicare patients, healthcare professionals that don’t take Medicare patients are encouraged to form such groups and some have already started doing so.
-Physicians don’t get paid more with more tests ordered anymore, on the contrary, they receive bonuses when they keep the cost low and focus on prevention. Basically, the healthier their patients the greater their savings and bonuses is.
-ACOs would pay flat fee for each patient being cared for.
- Clinicians have the responsibility of providing high level of health care standards other wise they jeopardize their savings and contracts.
-ACOs make referral within their network easy, but patients are still allowed to venture out at zero cost.
These are few of the building blocks ACOs stand for. The big question however becomes about who is qualified enough to lead and manage the teams, as well as finding a best combination of specialists to invite to join the organization. One of the advantages of this model is that ACOs can be managed by different sectors. They can be managed by hospitals through buying different practices or through hospital mergers. Doctors joining hands with different physicians and teaming up ,or they can be formed by insurers through establishing connections with certain hospitals, physicians, laboratories…. Insurers usually have the highest advantage in forming ACOs because they are the most familiar and experts in the financial and reward department. The idea of having teams based on different sectors could end up being a harmful effect for ACOS, which will be discussed in the section of disadvantages.
The fact that ACOs can be formed from different sectors in different fields, is important in differentiating and assessing the success of a certain team. A good leader plays a big role in achieving the best outcomes in such situations. Thus, leadership and governance structure is a major characteristic that can help physicians differentiate ACOs from one another (Edmiston& Wofford, 2010). The Medicare shared savings programs (MSSP) however have placed several restrictions on how an ACO’s leadership and governance…