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Accountable Care Organizations: Improving the Bottom Line Through Care Coordination
On January 1, 2012, the Centers for Medicare and Medicaid Services (CMS) put into effect its proposal to transform the Medicare program into one driven by the triple aim of obtaining better care for individuals, better health for populations, and reducing per capita costs. This rule signals a shift from provider-centric payment to rewarding patient-centric care coordination. The accountable care organization (ACO) model fits this shift in paradigm perfectly; at its core is the premise that a provider-led entity bears direct risk for quality and cost. Understanding how ACOs can improve health care quality while reducing costs is critical for health care professionals and organizations, both of whom can reap the benefits.
For physicians in solo or small group practice settings, the ACO offers the potential for better reimbursement, continued independence, more efficient claims management, and rewards for improved care delivery. For hospitals, the allure may be having independent physicians actively cooperating to control hospital costs, improve quality, and achieve pay-for-performance targets. Certainly, both of these parties are better poised for the new Medicare and Medicaid payment models that require such hospital-physician collaboration.
MedVentive Inc. (www.medventive.com), a Waltham, Mass.-based medical management company, has been helping physicians and hospitals form or advance ACO initiatives since 1997. “There’s a lot of uncertainty in health care ....
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