Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers, who come together to coordinated in order to provide high-quality care to Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, received the efficient, effective quality of care, and also avoiding unnecessary duplication of services and preventing medical errors. Moreover, while aiming to improve the quality of care and patient outcomes and lowering costs.
Medicare offers several ACO programs:
• Medicare Shared Saving Program: a program that helps a Medicare fee-for-service program providers become an ACO
• Advance Payment ACO Model: a supplementary incentive program for selected participants in the Shared Saving Program
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One great method for reimbursement and utilizing management would be the Pioneer ACO Model. The Pioneer ACO model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care setting (CMS, 2016). This will be a great benefit to patients, especially those who suffer from chronic illness. This is due to the model coordinate with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across ACO and thus, accomplish cost saving for
Balance sheet lists assets, liabilities and owner’s equity. The assets listed on the balance sheet are acquired either by debt (liabilities) or equity. “Companies that use more debt than equity to finance assets have a high leverage ratio and an aggressive capital structure. A company that pays for assets with more equity than debt has a low leverage ratio and a conservative capital structure. That said, a high leverage ratio and/or an aggressive capital structure can also lead
Cimasi, R. J. (2013). Accountable care organizations: Value metrics and capital formation. (pp. 90-92). CRC Press. Retrieved from http://books.google.com/books?id=EDMTlDWYvmUC&dq=specific service payment bundled&source=gbs_navlinks_s
Lischko A. (2011). Physician payment reform: A review and update of the models. Massachusetts medical society.
Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
The current focus on new healthcare models is a reaction to long-standing concerns around quality, cost, and efficiency. Accountable Care Organizations model focus on integrated healthcare to promote accountability and improve outcomes for the health of a defined population. The goal of integrated healthcare is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors (CMS, 2014). The following paper will analyze an ACO’s ability to change healthcare in the United States.
A mandate will be made through this health care reform plan that will make providers more involved in the care of their patients. Steps will be taken to help increase the number of physicians in areas experiencing shortages along with incentives for physicians to become family practitioners. Preventative care will be the focus therefore annual checkups and routine procedures will be covered by all insurances. A coordination track where doctors, nurses, and other providers work effectively and efficiently in teams, analyzing the outcomes and processes of care to rid the system of waste will be created (Cortese & Korsmo, 2009).
Be open to alternate reimbursement models. Many third-party payers are beginning to offer bundled payments. Providers should be opened to the many different reimbursement models to stay profitable.
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
In the quest for better and quality services, we have taken the following steps. First, integrating performance into our strategic objectives. We acknowledge that health care is definitely a complex, and adaptive systems where relationships and interactions of many different components simultaneously are affected and shaped by the system. As described, it is imperative to integrate performance improvements within the strategic objectives of the health care organization. Strategic objectives like focusing on populations health management, developing a center of excellence for cardiovascular services or even being an accountable health care organization (ACO), all need performance improvement so as to be
In recent times, healthcare organization across the nation are facing unprecedented challenges as they strive to improve the overall quality of care provided to their patient’s population, while improving their organization’s financial performance. Furthermore, uncertainty of new reimbursement models, diminishing reimbursement, and complicated compliance regulations are playing the role of a catalyst for streamlining the Chargemaster process in majority of healthcare organizations.
Reimbursement programs are a part of the United States health care system and they represent a financial tool for providing cash flow to service physicians and hospitals. Often times, the competency to provide quality health care is to be contingent on the payment for the services given by physicians and hospitals. Physicians that take part in the managed care systems are reimbursed by several different methods for their services. The two most common methods are Fee-For-Service or Capitation. Managed health care has grown considerably within the health care industry and Physicians have faced several challenges in establishing and financing payment systems for services. On the daily in the news you will see or hear about the financial savings resulting from managed health care as well as the restrictions on patient freedom. Insurance risk seems to be one of the less talked about concerns in the movement toward providing health care and professionals often ponder about who should bear the risk of insurance fees. For providers reimbursement is an essential portion of the managed care system. In order for them to receive their incentives to provide that efficient quality care they need to be reimbursed
Unfortunately, this era also witnessed tumor in the medical community as the American Medical Association (AMA) greatly opposed the prepaid plans of the early 1900s while favoring the indemnity- type insurance that reimbursed policyholders. Therefore with the pioneers of prepaid services encountering daring degrees of oppositions, a strategy to discourage such opposition led to the development of the early Independent practice associations (IPA) model HMO (Fox & Kongstvedt, 2015; Kongstvedt, 2009).