Roland Bartels
Contributing Author - Student with University of Minnesota Majoring in Health Managment
Accountable Care Organizations (ACOs) show us a way to improve efficiency along with quality in healthcare. They are voluntary groups of providers delivering coordinated care to Medicare patients. With a goal of improving health and obtaining financial incentives provided in collaboration with the Medicare Shared Savings Program (MSSP), ACOs display a potential future of healthcare.
The main idea of an ACO revolves around delivering quality, coordinated care. Fee-for-service payments don’t necessarily promote these facets of care. The reason to deliver a higher standard of care is for both increased population health as well as financial incentives. CMS’ Provider Engagement Toolkit outlines three requirements for these financial incentives:
- The ACO meets or exceeds a certain amount of savings.
- Savings are determined with yearly benchmark measures of financial data for the ACO. This means that the amount of savings an ACO receives is relative to their previous financial earnings.
- The ACO meets the quality performance standards.
- There are 33 ACO quality measures designed to determine the quality of care an ACO is delivering to its beneficiaries.
- Remain eligible for the MSSP.
- There must be at least 5,000 beneficiaries assigned to an ACO to qualify, among other requirements.
There is no magic way to determine if a healthcare organization or groups of providers should form an ACO. The chosen risk model determining the amount of risk and reward for an ACO, quality improvement initiatives, and staffing are all factors when looking at ACOs. Additionally, once an ACO receives their shared savings, they must determine the cash amounts they will invest into provider incentives and/or infrastructure improvements.
My Staffology has also written on the topic of “Gold Card” Insurance Prior Authorization as well as other options to help reduce costs of Health Care.
