Accountable Care Organizations (ACOs) is one of the new delivery and payment model designed to improve the quality of patient care while controlling healthcare cost. Despite its structure, ACO is believed that it should be accountable for the continuum of care for populations and be provider-led (Burns & Pauly, 2018). In addition, ACO should have payment methods to the provided incentive that lower costs and offer high-quality care. Besides, it is required that ACO engages in reliable measurements of performance techniques that ensure confidence in the care provided (World Health Organization, 2018).
Overview of Services and Initiatives for an ACO in Texas State
ACO evidence-based services/initiatives Matrix for Texas
Quality of care
The success was attributed to:
Obtaining buy-ins from physicians
The hiring of four nurse coordinators who cared for patients between their visits and the doctors
The building of robust health infrastructure that gave it data analytics needed by physicians to improve their performance, cut down wastage, and improve their performance.
As a result, the rates of admission of diabetes patients fell from 48.71 to 44.35% (Farias, 2019).
ACO hospitals are aligning their health information technology (HIT) with cost reduction and quality improvement strategic goals
ACO incentive can overcome meaningful use incentives thus, making hospitals to adopt technologies like exchange-oriented health and patient engagement health.
Texas hospitals consider adopting technologies that align their cost reduction and quality care improvement goals with their strategic goals.
Policymakers in Texas can consider aligning their meaningful use incentives with alternative payment and quality improvement models for hospitals, as it is done with eligible providers
In 2015, Rio Grande Valley Health Alliance (RGVHA) saved 14.2 million dollars with its population health approach and received $8.5 million translating to 75% of the money they saved in 2015 (Farias, 2019).
In 2017, they saved 9.8 million dollars and earned 6.8million dollars in return (Farias, 2019).
Population health programs
There is care coordination where nurse care coordinators visit or call their high-risk patients to intervene and prevent their conditions from worsening (“Accountable Care Organization Hospitals Differ in Health IT Capabilities”, 2019).
The care coordinators also focus on health determinants of their patients like missed dialysis session appointments, which lead to the realization that they lacked reliable transportation
Lyft and Uber were hired to take the patients to their appointments and ER visits, and hospital admissions were avoided in some cases.
As a result reduction of unplanned admissions has been realized, especially among congestion heart failure patients.
Electronic Health Records (EHR) has also been used to reconcile medication and provide physicians with a clear picture of drugs each patient is using (Farias, 2019).
Vertical versus horizontal integration
Vertical integration in the form of ownership of physician practices is associated with an increase in physician prices, per patient expenditure, and hospital prices.
Vertical integration can drive up cost without counterbalancing of utilization reduction.
Unlike horizontal integration, vertical integration can enhance market power and achieve increased efficiencies
ACO realized that operational excellence would be achieved by increasing patient satisfaction, reducing cost, and improving patient care (Farias, 2019).
Therefore, the need for actionable and timely data to achieve the goal of obtaining reliable data on the performance of providers is important.
The use of electronic health records from hired and trusted vendors is important in obtaining and reconciling patient and providers data.
Through ease of reconciliation of information, physicians can get historical data of the patient and provide right intervention hence achieving operational excellence ((“Accountable Care Organization Hospitals Differ in Health IT Capabilities”, 2019).
Accountable Care Organization Hospitals Differ in Health IT Capabilities. (2019). Retrieved 21 July 2019, from https://www.ajmc.com/journals/issue/2016/2016-vol22-n12/accountable-care-organization-hospitals-differ-in-health-it-capabilities
Farias, V. (2019). How Our Texas ACO Saved Medicare $14M with Population Health Approach. Retrieved 21 July 2019, from https://hitconsultant.net/2019/03/20/texas-aco-medicare-population-health/#.XTP5TPIzbct
World Health Organization, United States., France., & United States. (2018). WHO housing and health guidelines.
Burns, R., & Pauly, V. (2018). Transformation of the Health Care Industry: Curb Your Enthusiasm?. (Milbank quarterly.)
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