An Accountable Care Organization (ACO) is a networkof doctors and health care facilities that share the responsibilityfor the care of a group of patients. The ACO is paid for each person in its plan,which is a departure from the common model of paying a medical service provider foreach item of care provided. The more common model is known as “fee for service” medicine.
Accountable Care Organizations are a new concept, so they are just getting started. One healthcare consulting practice, Leavitt Partners, counted 221 ACO’s in 45 states as of May 2012.Source: http://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update2.pdfMedicare has played a large role in the creation of ACO’s. In July 2012 the Department of Health and Human Serviceslisted 154 ACO’s providing medical services to 2.4 million Medicare recipients.
Health care is expensive and many health economists believe that fee for service medicine encourages too much use of medical services.If a system can be created in which a team coordinates care, the thinking is that better common records will be used, duplicate testingwill be eliminated and the system will have more emphasis on preventing problems and catching those that arise early.
The ACO concept has some similarities to HMO’s in the 90’s. The public did not view those plans favorably because they exercisedcontrol over doctor referrals, which in turn created concerns that quality care was being compromised.The ACO experiment comes with measurements of the quality of the care provided, and financial incentiveswill encourage the ACO to provide quality care. Technological advancements in data records and analysis since the90’s provide solutions that were not available in the 90’s.
ACO’s have a great deal of potential, but it is still early in their development. If your primary physician is part of an ACO,have a conversation with her/him about what that means for you. Chances are you will see better health records, fewer duplicatedtests and more outreach on preventative care. Ask what facilities are part of the ACO if you need care for a major health concern.
ACO’s are too new to have significant data on quality and cost. However, HealthPocket uses current data to provide our userswith quality ratings of health plans. Select a plan with which you are comfortable. ACO’s have the potential to improve how healthcare is provided to you. Because ACO’s can move us away from an inefficient fee for service model, we will watch the data to see ifACO’s are able to have the combination of a good effect on cost and a strengthening of the quality of care provided.
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