Essay Sample on Impacts of Accountable Care Organization on Healthcare Providers and Patients

Introduction

Recently, there have been restructurings in the national healthcare programs modifying how Medicare is paid and organized. Policies have agreed on a new path for the health sector to create teams known as Accountable Care Organizations (ACOs). Accountable Care Organizations are thus a series of hospitals, physicians and other healthcare professionals who come together with the aim of sharing their responsibilities towards providing exceptional medical care to patients are reasonable prices. Currently, the United States has over seven hundred registered ACOs (Shortell et al., 2015). The primary objective of creating Accountable care organizations is to acquire extra savings on medical bills. Most of the baby boomers in the United States are on the verge of hitting their retirement age and will be at more need of healthcare as a result of age-related ailments. This liability of providing healthcare to the old individuals has an impact on those who are in the employment market as well as the nation's economy in general. The change in payment methods moves financial risk from sponsors like employers or insurance companies to the health care providers. Through this, health care professionals and hospitals are highly incentivized to modify their ways of providing care to patients by improving patient satisfaction and quality measures while reducing costs. Commercial health insurers, Medicaid plans, and Medicare have thus adopted the idea of the ACOs to try and reduce the costs of providing medical aid. This essay discusses the effects of having accountable care organizations on health care service delivery, and its impacts on healthcare providers as well as patients.

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Impact on Health Care Providers

The accountable care organization payment and service delivery approach brings into line the doctors payments with quality metrics with the attempt of reducing health care costs. In essence, the pay for hospitals and doctors depends on their aptitude of meeting quality of care indicators (Blackstone & Fuhr, 2016). Through ACOs, physicians get rewards for improving their patient's health status by giving the necessary care, at the right time, and in the right place. Instead of getting awards for the number of services or procedures carried out, ACO encourages providers to provide the highest value and most suitable care. If medical personnel are not able to maintain lower costs and improve the patients' health, they get a cut in reimbursements from Medicare (Blackstone & Fuhr, 2016).

Accountable care organizations also aids in fixing the fragmented nature of the current health care structure by enhancing communication and coordination between patients and providers, and among health care providers. Accountable care eases the work of health care professionals by merging the several components of the health care delivery system and guarantees that they all work as a team hence there is better coordination and sharing of information between the providers that would provide solutions to patients needs. Most accountable care organizations have coordination teams that consist of personnel predominantly dedicated to assisting patients access appropriate care hence making work coordination between different providers to be more swift, focused, and efficient (Shortell et al., 2015). Additionally, by electrically storing and sharing patient's records and holding health care providers accountable for the appropriateness, quality, and safety of care they give to patients, responsible care organizations help in evading duplicate or unnecessary procedures and tests.

On the negative side, there could be possible liability risks in case some errors develop. The potential danger is a failure to access patients medical data in case of the patient's reluctance to have their data stored in the ACOs database. In such a case, providers can have a hard time getting the patients medical history and consulting specialists on the best course of treatment for the individual (Shortell et al., 2015).

Effect on Patients

From the patient's perspective, the accountable care organization method could affect how they receive treatment throughout the treatment procedure. Every test and doctor's appointment can be achieved under one health care model. The point is that, if for instance a healthcare provider is offering treatment to a patient, and more review is required from a specialist, the doctor can then refer the patient to the specialist under the accountable care organization, and they would not have to incur extra charges.

Since ACOs are intended to create proceeds by making patients satisfied with health care services, when they were in their initial stages of development, patients allegedly said they were certainly contented with the level of healthcare-acquired from an accountable care organization. While payment shifts from fee-for-service towards motivations of limiting healthcare costs, ACOs were seen to accomplish significant advances for patients in certain crucial areas (Shortell et al., 2015). These advancements include substantial new improvements in promoting first-class, patient-centered care in Medicare. Payment in the accountable care organization model is not restricted to one method. Capitation, which emphasizes on healthcare providers being employed through a health maintenance organization is also a commonly known method of offsetting bills (Blackstone & Fuhr, 2016). Free for service payment, takes place when doctors get an enticement retrospectively for a surgery, test, consultation, or other healthcare services. ACOs also facilitate better care experience and health outcomes for patients by refining care harmonization ACO care facilities and providers, making full use of HIT, and forming associations with families and patients which aid them in being implicitly involved in their treatment process.

Conclusion

Accountable care organizations are designed to oversee improvement in the experience, value, and quality of care for patients by modifying health care delivery and payment. When appropriately done, ACOs open prospects of moving away from fragmented or inefficient health care organizations and towards a coordinated care structure which merges hospitals, specialists, and primary care providers, and makes sure that all sectors work as a team in coordinating care in the best interests of the patient. For patients, searching for hospitals and health care providers who take part in ACOs could be a beneficial step, both for their ease of treatment as well as financial gains. Accountable care also encourages increased family and patient communication and ensures that the sick become vibrant partners in the treatment process. This approach to health care delivery improves how ill-health individuals get treatment over time. When there is record sharing, and doctors and hospitals agree with being accountable to each other, the margin error becomes less. Although it does not mean that no issues would come up, at least the likelihood would be low, and even if the problems developed, then they would be at a minimal rate. Health care providers should thus be accountable to their colleagues and patients by joining ACOs which is also for their own professional and personal gains. As recipients of health care turn out to be progressively answerable to their health results, more emphasis on ways of improving client experience is essential.

References

Blackstone, E. A., & Fuhr Jr, J. P. (2016). The Economics of Medicare Accountable Care Organizations. Journal of American health & drug benefits, 9(1), 11-19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822974/

Shortell, S. M., Colla, C. H., Lewis, V. A., Fisher, E., Kessell, E., & Ramsay, P. (2015). Accountable Care Organizations: The National Landscape. Journal of health politics, policy, and law, 40(4), 647-668. doi: 10.1215/03616878-3149976