Accountable care solutions are a health management system that can be described in a number of ways. The goal of this type of system is to provide care for the whole individual, and reimbursement is not based on each procedure but on the treatment of a specific disease or condition. With this type of system in place, quality care is the key. There are caps placed on the total reimbursement for each patient to treat the disease or condition, without worrying about each specific procedure.
Reduce Costs While Improving Overall Care
Any health care system’s goal is to keep costs down while at the same time improving the overall care of the patients being treated. The value-based payment models are beginning to take hold in some areas, but in some places, this type of model isn’t being embraced. The fee-for-service model continues to be a traditional model and is one under close scrutiny to see if this system can bring costs down while still providing quality care.
Shifting From Fee-for-Service to Fee-for-Value
To remain financially solvent using a fee-for-value model, the supplier must be excellent at providing preventative care and not be focused on acute, emergency level care. When preventative care is at the forefront, the savings are in the form of less need for emergency level and acute care. Once this model is implemented, patients see a higher quality of life and spend less time getting treatment in the emergency room. This is a model that promotes wellness, instead of the fee-for-service model which handles problems as they arise.
The Problems with the Fee-for-Service Model
This model is the traditional healthcare model that has been in place. With this model, patients are treated on an as-needed basis, and they may get repetitive testing done that isn’t necessary. This model drives up health care costs as more people rely on emergency medicine instead of preventative care with a primary care physician. Each service provided is a cost to the insurance company, and fee-for-service agencies can only remain solvent when the higher number of people they treat. With a focus on quantity and not quality, the success of these treatments goes down. With costs rising and patients continuing to decline, this model is ineffective at bringing down the high costs associated with medical care.
Why Accountable Care Solutions Works
This is a model in which providers are accountable to each other, and there are incentives in place for keeping patients healthy. There will be saved when patients spend less time in acute care, and this model reimburses health care providers when they succeed at limiting the amount of acute care or emergency services patients require. When the insurance company saves money, the overall costs of health care premiums can decrease.
In this model, the whole condition of the patient is treated. Reimbursement depends on the disease being treated, and not on the number of tests or lack of tests the patient receives. While this can decrease the initial money coming in for the health care agency, getting the patient well using this model will decrease their reliance on the emergency health care system. This drives costs down. Patients who are using preventative care remain out of the emergency room and are admitted less often than those who wait until they are in crisis to receive medical care.
For patients, health care providers and health insurers, the only way to get costs down while providing quality care are to focus on the treatment of the disease from start to finish and not focus on each individual form of treatment for payment.
Population Health Management
One characteristic of an Accountable Care Organization that most people don’t know about is the tie into helping a population to be more healthy. Healthcare organizations are being held responsible for having an appropriate number of physicians, specialists, and variety of locations to help serve the community in which they are located. This helps to prevent sending patients to other hospitals or organizations unless absolutely necessary.
Many organizations have taken this opportunity to work more closely in the communities they serve, become more involved with community activities, help sponsor events so as to be more widely recognized, and get out information to help the community to live a healthier lifestyle. Specifically, many organizations hold free or low-cost flu shot or exam days or supporting marathons. Movements like this help to get the word out to people, but also to build a relationship within that population that can last generations.
“Accountable care organizations’ is jargon for the radical concept that when doctors and nurses actually talk to each other about shared patients, there will be fewer mix-ups, less duplication and patients will receive better, more convenient care at a lower cost. Markets created the first ACOs, including Kaiser Permanente, more than six decades ago. The federal government, in contrast, has long tried to ensure that nothing so sensible ever happens.” Michael F. Cannon, director of health policy studies at the Cato Institute
All of these together help to establish an organization as an Accountable Care Organization, and one that can make a difference for everyone. Being considered an ACO helps to demonstrate that they have prioritized the care of their patients and cost-cutting measures are important, while not willing to sacrifice attention to patients in treatment. Everyone benefits and the risk of potentially not getting paid for services provided isn’t really a risk at all.