You have seen advertisements about the Commonwealth Accountable Care Organization that has been joined by many local primary care physicians. We are unifying to serve the Northern Arizona Community, including Medicare and third party payer patients providing essential health care needs.
What is an ACO?
Simply stated, an accountable care organization (ACO) is a group of health care providers who agree to share responsibility for the quality, cost and coordination of care for a defined population of patients. This group can be nearly any combination of group practices, networks of practices, hospitals, hospital employed providers or hospital-provider joint ventures. An ACO works with one or more payers (most commonly Medicare) to achieve the triple aim: improving population health, improving patients’ experience of care, and reducing the total cost of care. If an ACO saves money for the payer without compromising quality, it shares in the savings. A successful ACO empowers primary care physicians with resources, data and leadership to coordinate and mange care for patients across the entire community.
Accountable Care Organizations are working now. However, no one knows how successful they will be over the long run. The potential for shared savings as well as improved patient care demonstrated through outcomes makes them worth serious consideration.
Why is Health Care Delivery Reform as Proposed in the Affordable Care Act Necessary?
The various delivery-system reform provisions of the Patient Protection and Affordable Care Act and the Health Care Education and Reconciliation Act – together known as the Affordable Care Act (ACA) – strive to achieve the three-part aim previously mentioned: improving the experience of care for individuals, improving the health of the populations and lowering per capita costs. In order to achieve these goals, the existing payment models and health care delivery system need to be reformed.
Despite general public perception, the healthcare system of the United States does not deliver the best care it can. Yet, it is the most expensive healthcare system in the world. The ACA aims to move the healthcare system away from its current episodic fee-for-service payment approach and toward a coordinated model that is focused on delivering high quality, low-cost care across the continuum of care. The current fee-for-service method of paying for health care can create incentives for providers to deliver more care, but not necessarily better care.
Developing a payment system that rewards quality outcomes and stewardship of healthcare resources is necessary for America to rein in its costs and improve the overall quality of the healthcare system. In changing the method through which providers are paid for healthcare, it is also necessary to reform the way in which that care is delivered. The plan is to reform the delivery system by creating high-performing organizations of physicians and hospitals that use systems of care and information technology to prevent illness, improve access to care, improve safety and coordinate services. With those goals, we must become accountable for the quality and cost of American health care.
What is the Importance of Linking Outcomes Measures to Payments?
For too long, the American healthcare system has not been effective in delivering quality health care to all Americans or in managing our health care dollars. The health care costs for our nation are ever-increasing and our system is the most expensive in the world, yet measures of medical quality indicate that we are not living more healthily or receiving the best care we can for the dollars we are spending.
And one reason why is that the current fragmented, volume-based system is not accountable to payers or consumers and is unsustainable. The Affordable Care Act recognizes the need for care coordination and accountability. In order to assure such health outcomes, performance measures are needed to assess whether or not payers and consumers are getting value for their health care dollar.
The providers of the Commonwealth ACO Flagstaff are embracing the challenges of the Affordable Care Act.
By By Brad Croft, M.D. and Cindy Martin, M.D.
Brad Croft, M.D. is from East Flagstaff Family Care and Cindy Martin, M.D. is from Flagstaff Family Care Clinic. Flagstaff Family Care Clinic can be reached at 928-527-4325