Question

Can someone explain Accountable Care Organization to me.

Answer 1

Ans) An Accountable Care Organization is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care.

- ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation.

- Goal:

Ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

- Outcome:

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

Payment models in an ACO:
-capitation
-bundled payment
-shared savings

ACO targets high risk patients:

-apply quality measures (many medication related)
-case management
-care coordination

Benefits of ACO:

- The benefits of ACOs are numerous and there are many stakeholders who obtain advantages from this model of care. The patient community gains a wide number of advantages including improved outcomes, better quality of care, greater engagement with providers, and an overall reduction in out-of-pocket costs.