Home Company Current Issue Departments Article Index Issue Downloads Contact Us

List Articles by:

Department >
Topic >
Author >
Issue Date >

Accountable Care Organizations: Improving the Bottom Line Through Care Coordination

May 2012
Health Care Trends

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.

Coordinated Care
According to CMS’s definition, an ACO is a group of providers of services that work together to coordinate care for patients. Although the term was not coined until 2006, these types of programs have been evolving since the 1980s, when physicians and hospitals starting banding together to better manage care and financial risks and gain payer contracts. They have also been referred to as clinically integrated physician-hospital organizations (PHOs).

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 ....