Question

NO SCREENSHOTS.

Discuss the differences and similarities between Managed Care Organizations (MCOs) vs. Accountable Care Organizations (ACOs). Given the current health care environment, provide a solid speculation to how MCOs and ACOs may transform to meet the needs of its consumers. Be sure to support your thoughts and analysis with scholarly sources.

Answer 1

The differences and similarities between Managed Care Organizations (MCO) and Accountable Care Organizations (ACO) will be explained below.

The MCO is a group of medical providers and facilities that provide care to its members at a reduced cost. Many MCO’s require the patient to have a primary care provider. The ACO is a group of medical providers and medical facilities that work together to provider collaborative care to its members. The ACO doesn’t require the member to have a primary care provider.    The providers work together voluntarily to provider care as a medical team for the patient. The different specialties work with each other to treat the patient with continuity of care. The information is shared so that all the providers that are treating the patient are aware of the medications, tests, hospital visits, and treatment the patient has currently and the past treatments. The providers that are part of the MCO’s don’t work as a team to provider collaborative care to the patients. They don’t strive to work together to treat the patient with the team approach like providers in the ACO’s strive for. The MCO groups can share information if it is requested. The focus is not continuity of care. Some providers send their notes to the referring provider as a courtesy. The ACO’s are still changing to become better. The MCO's and ACO's may transform and merge into one entity to meet the needs of consumers. They both are similar enough to the point where I think they can be combined with the best interest of the consumer in mind. I believe that we can take the best features from both of them. Considering the current health care environment , continuity of care is important. This is the best way to treat the patient with the best possible outcome. Having the providers work together as a team avoids having the patient take medications that interact, repeating the same tests, and other wasteful or harmful medical practice. This approach can also reduce the cost of medical care. The cost of medical care is constantly increasing and I think this is a way to reduce the cost of medical care. This will help control wasteful spending.

Options
There are so many possible scenarios. The hypothetical at the start of this chapter is only one.
The situation will be much different for a physician in a small rural area or specialists in a large
single-specialty group. A large multi-specialty group will also have a different situation. Much
will depend on the number of hospitals in the physician’s locale. The possible circumstances are
virtually endless. However, as a prelude to the rest of this Physician Guidance, the following is a
list of some of the options available to physicians, which will be expanded upon in later chapters.
1. Don’t do anything. This is certainly a possibility for some physicians in unique situations.
For example, physicians specializing in in vitro fertilization may be able to continue to
practice as they have been because of their unique market, which is driven by patient choice.
Other physicians may prefer to continue on in small practices. A larger specialty group that
has not seen substantial reductions in compensation may be able to watch and wait. A large
multi-specialty group may have enough leverage in a particular market to stay independent
while demanding support from integrated delivery systems.
2. Stand pat but attempt to grow the practice. One fact that seems to be clear even in the
muddled situation that we face is that larger will often be better. Consequently, a smaller
group of physicians that is not under immediate financial pressure can continue its present
course but attempt to grow by adding physicians or merging groups. Whatever the payer—
insurance company, ACO, medical home, Medicare, Medicaid—there will be a need for
physicians to provide the services. If the medical group is of substantial size and can deliver
a substantial number of physicians to the payer, the group will generally be in a better
position to negotiate rates and document its quality. This larger size will allow the group to
be more flexible as it adapts to whatever may come in the future.
3. Employment by hospitals. This may be a way for many physicians to eliminate substantial
administrative responsibilities while aligning with the hospital system that can provide the
infrastructure to be able to compete in a world increasingly dominated by integrated delivery
systems.
4. Form large clinically integrated practice associations that can negotiate as one. As such,
these large clinically integrated systems may be able to provide substantial numbers of
physicians to the various integrated delivery systems, such as ACOs or hospital-integrated
systems. By doing so, the individual physician groups could remain largely independent and
negotiate as one to seek better positions in these integrated delivery systems, both in terms of
control and reimbursement.
5. Changing to a concierge or direct practice. This method of practice will, in all likelihood,
still be viable after the insurance reform provisions of the ACA take effect. People may be
willing to pay for personalized care beyond their insurance premium. As long as this type of
practice methodology is not outlawed, it certainly may remain a viable option.
6. Partnering with hospitals. Physician groups may be able to develop service-line
management companies by which they can retain some independence but receive
compensation from the hospitals for providing management services of a specific service line
within the hospital. Another example is to utilize the medical staff relationship with the
hospital to try to develop a partnering structure for ACOs or integrated delivery systems.
This will be dependent upon the attitude of the local hospital.
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7. Partnering with health insurers. Physicians may also want to consider arrangements with
health insurers to obtain the capital and data necessary to operate an ACO. This scenario may
allow physicians to reduce hospitalizations without the potential pushback of a hospital
partner. However, the success of such a venture will depend on the willingness of the health
insurer to cede significant control to the physician group.
In analyzing and evaluating these various options, physicians will have to be very objective and
candid about their situation in the market.
 If you are a solo practice in a large city, you will have to recognize that your ability to
continue in that practice will likely depend on your willingness to take reduced income or
switch to a concierge-type practice. However, your ability to secure a beneficial employment
agreement with the hospital may be limited as well, depending on your specialty.
 On the other hand, if you are a small practitioner in a small town, your importance to the
local hospital may give you the clout to secure a strong relationship with the hospital,
potentially without becoming a hospital employee. If that hospital is going to be able to deal
with integrated delivery systems or insurance companies, it is going to need your allegiance
and support. The hospital may threaten to bring in a competing doctor, but that may not be a
real threat given the shortage of physicians.
 If you are in a position where you might be able to develop a large clinically integrated
organization, you must understand that that is going to cost substantial amounts of money,
time and resources. It is not something that can be undertaken lightly. Therefore, if you want
to commit to developing such an organization, you must make sure that the resources are
available to help you complete your efforts.
 You may be a substantial multi-specialty group. In that case, you may want to consider
potential hospital partners that recognize your value. You may be able to develop a
relationship with a hospital partner that allows you to maintain a substantial amount of your
autonomy while giving the hospital what it needs with your participation in its integrated
delivery system. Alternatively, there may be a health insurer that is interested in affiliating
with you and providing significant capital and technological resources.
In making an assessment of options, it is very important to be extremely realistic about your
group’s strengths and weaknesses. These are some of the questions that need to be asked:
1. Is your group on sound financial footing, and can you continue to sustain reasonable
incomes over the next five to six years?
2. Is your group going to invest in some of the infrastructure—both technological and
human—that will be needed to compete with more sophisticated integrated delivery
systems?
3. Does your group have strong and deep leadership with cohesion among the members? If
you don’t have both of those characteristics, staying the course may be difficult.
4. Who are the realistic partners you might work with, and how trustworthy are they? There
are differences between hospitals and medical groups in their reliability and credibility.
When you can, it is better to partner with a reliable party rather than one who offers more
money at the outset but cannot be counted on to stay the course.
5. What is your bargaining position in the community? Are you well-thought of, and do you
bring sufficient capacity to give you substantial leverage? If not, it is important to
evaluate what kind of leverage you might have and how you might strengthen it. Is your group prepared to spend the time and resources it will take to carve out a strong
position in any joint venture such that the group or the physicians in it will have a
substantial say in that new, combined organization? It will take time and money to put
your group in a position where it will have a substantial say in any organization, be it an
ACO or integrated delivery system. If the group doesn’t want to spend that time and
money, it is probably best not to reach too high for a leadership position.
7. What is your plan for the future? Are you close to retirement or in the prime of practice?
If the former, you may want to try to obtain the best money deal possible. If the latter,
you may want to choose a partner for the long-term. This difference in perspective can
create difficulties between members of the same practice when making group decisions..