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Accountable Care Organizations: Access and Providers

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Does a patient's choice of provider and access to care will be limited under Accountable Care Organizations (ACO)?With an ACO, you'll likely have fewer repeated medical tests because your doctors and hospitals will share information and coordinate your care. Is this a reality or not? In what ways can an ACO succeed in both delivering high-quality care and spending health care dollars more wisely?

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Do a patient's choice of provider and access to care will be limited under Accountable Care Organizations (ACO)?

Given that participating in an ACO is strictly voluntary, choice of providers and access to care will be limited. According to CMS, there are several guidelines and restrictions that apply to being in the ACO which may prevent some physicians from signing on. The key to ACOs is care givers working collaboratively and collectively towards accountability for quality and cost of care. Kaiser Permanente, an HMO, has a working model that could easily fit the ACO in with success.
Source: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/Downloads/Appendix-ACO-Table.pdf

With an ACO, you'll likely have fewer repeated medical tests because your doctors and hospitals will share information and coordinate your care. Is this a reality or not?

In theory it can be a reality. However, CMS has ...

Solution Summary

This response discusses the new Affordable Care Act, health insurance providers and CMS are working towards a model to care for Medicare patients that will yield lower cost, higher quality of care, and a reduction in repeat hospitalizations. Is this a reality or just hopeful thinking?

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Accountable Care Organizations..

Scenario: Medicare and private payers have expanded reimbursement under Accountable care organizations (ACO). You are the chief financial officer (CFO) of a hospital system that is forming an ACO to participate in these payment models. The ACO seeks to improve care coordination for its patients with chronic conditions. To provide better care management, the ACO is interested in investing in primary care physicians and physician's assistants to provide more intensive care management services. After formation, the ACO will enter contracts with Medicare and private insurers under alternative payment models, including shared savings, bundled payments, and global capitation. The ACO will need to determine how to set up reimbursement payments to ACO providers and consider whether financial incentives are required to ensure ACO providers deliver efficient care.

Consider strategies for reimbursement and utilization management, including financial incentives.
How might you set up the reimbursement payments to ACO providers, considering the alternative payment models (i.e., fee for service, shared savings, bundled payments, or global capitations)?
What utilization management controls might you add to align the interests of ACO providers?

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