One of the biggest concerns with the healthcare system is that providers and medical facilities primarily operate in silos. This silo approach to medical care means patients have to repeat tests, fill out numerous forms and questionnaires, pay multiple bills, keep track of files and files of medical information, which have to be carried to every medical appointment, and higher costs for everyone.
Accountable Care Organizations, known as ACOs, aim to breakdown silos, promote sharing of information and reduce costs. ACOs connect the components of patient care such as primary care, specialists, hospitals, home health, therapy, billing, etc. This connection allows each individual component to work together in a more coordinated fashion with the goals of quality healthcare, increased efficiencies and decreased costs.
Healthcare providers and hospitals refer patients to physicians, specialists and hospitals within the ACO network in which they belong. However, patients are still free to see the provider of their choice outside the ACO without any sort of penalty.
By creating a network of providers and services, ACOs can reduce hospital stays, emergency room visits and repeat medical tests. ACOs do this by sharing information and working together to develop a coordinated platform of care for the patient. This approach also decreases costs, for the patient as well as providers and hospitals.
Traditionally, healthcare providers and facilities operate in a fee-for-service payment system. This means they get paid for each test and procedure, each visit or appointment. This payment system drives up costs because patients and insurance companies end up paying for multiple, often repeat, tests, procedures and appointments.
ACOs don’t eliminate the fee-for-service system; rather, they provide a financial incentive to be more efficient, decrease costs and meet specific quality benchmarks. These benchmarks focus on wellness and prevention and carefully managing patients with chronic diseases. In other words, providers and insurance companies get paid for keeping their patients healthy and out of the hospital. A focus is placed managing the health of their patients, not just caring for them when they are ill.
How ACOs work:
Local healthcare providers and hospitals volunteer to work together to provide quality, cost-effective care.
Physicians, hospitals and other healthcare providers in the ACO share patient medical records to allow for increased coordination of patient care.
Patients approve the sharing of their medical records and can determine who has access to their private medical information.
Patients don’t sign up for an ACO. The organization’s members are the providers, hospitals and private companies who choose to be part of its network.
Less time is spent filling out forms and entering information into electronic records because information is shared electronically between providers via secure electronic medical records.
Fewer repeat medical tests are ordered because physicians can share medical information.
Physicians, patients and insurance companies work together to promote wellness and to prevent illness.
Unlike health maintenance organizations, or HMOs, that were popular in the 1990s, ACOs do not dictate which provider(s) patients must see. FBN
PathfinderHealth is a collaboration of more than 450 healthcare practitioners, including 36 medical specialties and 40 physician practices, across Northern and Central Arizona. The company is a subsidiary of Northern Arizona Healthcare, but is overseen by a separate 14-¬member board of directors comprised of local physicians. To find a PathfinderHealth provider or to learn more about PathfinderHealth, visit PathfinderHealthACO.org.
Maggie Lewis, M.Ed., is the director of Development and Operations for Pathfinder Health.