This paper provides a discussion and detailed analysis of the development, performance, and importance of Accountable Care Organizations as a vital component of health care reform from the time of the passage of the Affordable Care Act in 2010 through early 2015.
Compare and contrast conflict visions in healthcareNicole Valerio
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A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Linkages Between the Essential Health Services Package and Government-Sponsor...HFG Project
Priority setting is a key function of health systems that seek to achieve universal health coverage. The Essential Health Services Package (EHSP) explicitly prioritizes certain services; government-sponsored health benefit plans implicitly prioritize others. To gain insights into the purpose, policy objectives, and governance of the EPHS and dominant health benefit plans in Ethiopia, we conducted a case study in 2016. Methods included a desk review of relevant documents and qualitative analysis of 15 key informant interviews of leading health finance experts in Addis Ababa. All data were coded and analyzed using a thematic inductive framework.
Compare and contrast conflict visions in healthcareNicole Valerio
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We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
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A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Linkages Between the Essential Health Services Package and Government-Sponsor...HFG Project
Priority setting is a key function of health systems that seek to achieve universal health coverage. The Essential Health Services Package (EHSP) explicitly prioritizes certain services; government-sponsored health benefit plans implicitly prioritize others. To gain insights into the purpose, policy objectives, and governance of the EPHS and dominant health benefit plans in Ethiopia, we conducted a case study in 2016. Methods included a desk review of relevant documents and qualitative analysis of 15 key informant interviews of leading health finance experts in Addis Ababa. All data were coded and analyzed using a thematic inductive framework.
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Analysis of the medicare three day inpatient hospital stay rule...Philip McCarley
Policy analysis of the Medicare three day inpatient hospital stay rule for determining eligibility for post-hospital care in skilled nursing facilities with further considerations of the impact of increased utilization of observation status classification.
SOCW 6351 Wk 9 Discussion 1. Need Responses.Respond in one of t.docxrosemariebrayshaw
SOCW 6351 Wk 9 Discussion 1. Need Responses.
Respond in one of the following ways:
· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).
References:
HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
Wachino, V., A.
Running Head HEALTHCARE STAKEHOLDER CONFLICTS1HEALTHCARE .docxcowinhelen
Running Head: HEALTHCARE STAKEHOLDER CONFLICTS
1
HEALTHCARE STAKEHOLDER CONFLICTS
5
Stakeholder Conflicts in Healthcare Visions
Kendra Smith
Grand Canyon University: HCA 675
Introduction
The stakeholders in the healthcare service in any jurisdiction entail the government, the healthcare providers or the physicians, the payers, the patients as well as healthcare professional organizations.
These stakeholders work hand in hand to ensure efficiency and professionalism in healthcare delivery (Blair et al, 1988). They do this by developing succinct policies and effectively implement them for the sole purpose of improving healthcare services. However, there have been serious conflicts in opinion regarding enhancing healthcare service practices and proper administrative mechanisms for the achievement of better services, among the stakeholders.
Conflicts in Health Vision
One of the major health reform visions which have generated considerable debate concerns the accommodation of evidence-driven healthcare service practice, which the government of the United States has instructed all healthcare service providers or organizations to adopt. The major emphasis on this aspect of medicine is the requirement by the government that all healthcare service providers or organizations should document which healthcare services they provide and why they provide such healthcare services to the communit
y.
The argument behind this requirement is that it will enable the government, or it will be generally helpful in gauging the benefits the community gains from such healthcare services. In addition, establishing evidence-driven healthcare practice according to healthcare practitioners will help in identifying specific health problems within a community, and subsequently, design the most appropriate medical response. Some healthcare stakeholders also believe that this is an avenue that the government intends to use in creating and forging a closer working relationship between private and public healthcare providers. However much most stakeholders, both private and public, appreciate this evidence-based healthcare practice, as a vital component in improving healthcare services, the major concern is about how such data should be obtained. Some healthcare providers have reasoned that these data should be generated from the already existing data, due to the costs associated with activities that may lead to acquiring and establishing sound data or information domain. In response to this requirement, most of the healthcare organizations have established community-based information or data collection and management mechanisms, which enable them to collect data concerning community health concerns and threats, then define effective ways of response.
With the introduction and implementation of a series of healthcare reforms in the United States, such as the Obamacare and Trumpcare, there is general expectation that there will be enhanced access to healthcare service ...
Unintended Consequences of Health Care ReformThe PPACA of .docxgibbonshay
Unintended Consequences of Health Care Reform
The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.
Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.
This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.
To prepare:
Review this week’s media presentation and the other Learning Resources focusing on how reform may lead to improved quality, greater access, and reduced cost of care. Also think about the unintended consequences that may arise as a result.
Consider the information presented about the individual mandate and accountable care organizations. What are some questions or concerns you might have regarding the individual mandate? What are the pros and cons associated with becoming an accountable care organization?
With posting instructions in mind, select either the individual mandate or accountable care organizations as the focus of your Discussion this week.
By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum of 550 words in APA format with a minimum of
THREE
scholarly references from the list of required readings below. Include the level one headers as numbered below:
Post
a cohesive response that addresses the following:
1) In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.
2) Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession ( I WORK I A HOSPITAL SETTING).
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”
Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”
McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3 ...
Market Power, Transactions Costs, and the Entryof Accountabl.docxinfantsuk
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
Assignment 1Public Administration – The Good, th.docxtrippettjettie
Assignment 1
Public Administration – The Good, the Bad, the Ugly
hhhhhhh
Modern Public Administration
Prof. hhhhh
Date: hhhhh
The White House Issue: Health reforms
The Health Care Reforms are the best obsession for the United States, Majorly most of the American citizens who were responsible for originating the improvement found it helpful. Back in the year 2011, a countrywide crackdown was conducted as a way to oppose the frauds that were becoming a health concern, and the federal administration recovered almost $ 4.1 billion. The Health Care Improvement for capturing the healthcare frauds and scams allowed President Obama’s policy to enhance on strict penalties like compensation and fines. By providing the United States citizens with Patient Protection as well as, ACA (Affordable Care Act) was the ultimate presidential success for President Barack Obama (.whitehouse., 2014).
The public policy
As most of the leaders decided to adopt a firm stand with the many important issues within the American State, the essential point was the definition of the improvement of the Health Care in the United States by President Barack Obama and when discussing the fitness and care reform a lot of issues are put on focus.
The public policies are categorized into four groups which are the regulatory policy, the distributive policy, the redistributive policy and lastly the constituent policy. Every issue in the White House is organized it the way it is related to any of the four types of public systems (NCBI, 2016). The financial regime faces most of the significant issues, and many may need to be in a position to determine the problems which are related to funding system because some of these issues affect some of the American citizens.
Distributive policy as mentioned above, it is a policy that focuses on supporting the selected issues; the strategy that is behind the distributive health care is the local understanding and having a flexible organizational design. The idea of distribution is quite broad as it classifies distributive policy action towards including all the public processes that are responsible for developing as well as providing equitable access to the resources. In regards to the health issues, this may have financial aid for assisting the excluded to have access to the healthcare. Also, across funding aid to assist in the inside operations of the health institutions such as the combination of threats which enhances the inclusion of reasonably inadequate health services. Also, the appointment systems facilitate the secondary concern for the needy to access health services (Mackintosh, 2013). It also reduces the shifts regarding the fitness care regime in processes that will be able to satisfy and offer the proper access to those who are deprived by supporting the distributive promises that the government has made and having full access to healthcare services. In this kind of shift, the significant disadvantage is ...
Study Guide Health Care ReformHealth Care Reform OverviewWhe.docxpicklesvalery
Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe that more is better--but does more healthcare result in better health? As a nation, we spend more on healthcare per person than any European country, yet our health outcomes are worse. The PBS documentary, Money and Medicine was aired in 2012, and addresses one of the key issues of healthcare reform--the cost of health care. Watch the trailer below, or the entire episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
(Links to an external site.)
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed in 2010, is a collection of laws that were created to reform health insurance and healthcare.
The ACA significantly impacts nurses both personally and professionally. Bedside nurses are impacted by organizational changes that affect patient care, and may be providing information and resources to patients and caregivers about the ACA. However, as Hynds, Hatch and Samuels (2014) noted, nurses indicate they need more knowledge to understand the ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you can watch this short, animated video produced by the Kaiser Family Foundation, and visit the helpful online resources below:
http://youtu.be/JZkk6ueZt-U
(Links to an external site.)
The YouToons Get Ready for Obamacare
0:01 / 6:52
<div class="player-unavailable"><h1 class="message">An error occurred.</h1><div class="submessage"><a href="http://www.youtube.com/watch?v=JZkk6ueZt-U" target="_blank">Try watching this video on www.youtube.com</a>, or enable JavaScript if it is disabled in your browser.</div></div> Minimize Video
Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online, interactive resources to illustrate the impact of the Affordable Care Act in its first five years of implementation. Through personal stories, population and health systems data analysis, and graphics, the Commonwealth fund paints the picture of the impact of the ACA on individuals, businesses, providers and healthcare systems. Take some time to explore these resources in preparation for this week's discussion board. Link: The Affordable Care Act: A Look Back at the First Five Years.
(Links to an external site.)
Review the two interactive digital features: Coverage Reform
(Links to an external site.)
and Delivery Reform
(Links to an external site.)
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed not just for the amount of services provided (fee-for service), but for the results that are achieved for a particular patient population. As nurses, you may have observed policy changes that emphasize patient experience, prevention of hospital-acquired infections, and effective discharge planning ...
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
India Diagnostic Labs Market: Dynamics, Key Players, and Industry Projections...Kumar Satyam
According to the TechSci Research report titled “India Diagnostic Labs Market Industry Size, Share, Trends, Competition, Opportunity, and Forecast, 2019-2029,” the India Diagnostic Labs Market was valued at USD 16,471.21 million in 2023 and is projected to grow at an impressive compound annual growth rate (CAGR) of 11.55% through 2029. This significant growth can be attributed to various factors, including collaborations and partnerships among leading companies, the expansion of diagnostic chains, and increasing accessibility to diagnostic services across the country. This comprehensive report delves into the market dynamics, recent trends, drivers, competitive landscape, and benefits of the research report, providing a detailed analysis of the India Diagnostic Labs Market.
Collaborations and Partnerships
Collaborations and partnerships among leading companies play a pivotal role in driving the growth of the India Diagnostic Labs Market. These strategic alliances allow companies to merge their expertise, strengthen their market positions, and offer innovative solutions. By combining resources, companies can enhance their research and development capabilities, expand their product portfolios, and improve their distribution networks. These collaborations also facilitate the sharing of technological advancements and best practices, contributing to the overall growth of the market.
Expansion of Diagnostic Chains
The expansion of diagnostic chains is a driving force behind the growing demand for diagnostic lab services. Diagnostic chains often establish multiple laboratories and diagnostic centers in various cities and regions, including urban and rural areas. This expanded network makes diagnostic services more accessible to a larger portion of the population, addressing healthcare disparities and reaching underserved populations. The presence of diagnostic chain facilities in multiple locations within a city or region provides convenience for patients, reducing travel time and effort. A broader network of labs often leads to reduced waiting times for appointments and sample collection, ensuring that patients receive timely and efficient diagnostic services.
Rising Prevalence of Chronic Diseases
The increasing prevalence of chronic diseases is a significant driver for the demand for diagnostic lab services. Chronic conditions such as diabetes, cardiovascular diseases, and cancer require regular monitoring and diagnostic testing for effective management. The rise in chronic diseases necessitates the use of advanced diagnostic tools and technologies, driving the growth of the diagnostic labs market. Additionally, early diagnosis and timely intervention are crucial for managing chronic diseases, further boosting the demand for diagnostic lab services.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
The significance and function of accountable care organizations
1. ShepherdUniversity
The Significance and Functionof
Accountable Care Organizations as a
Vital Component of the Affordable
Care Act and Health Care Reform
A Discussion of the Development,
Performance, and Importance of ACOs
Philip McCarley
2/23/2015
2. 1
Introduction
During the past century attempts to reform the basic structure, financing and delivery of
health care in the United States met with great resistance from political and business
stakeholders. Berkowitz provided a thorough historical review and analysis of “the
transformation of the idea behind national insurance during the period from 1900 to 1965”
(Berkowitz, 2008). Since the historic passage of Medicare and Medicaid in 1965 the complexity
and the cost of providing care has grown steadily and rapidly. With the increasing costs and
strain on the system, particularly with the demographic fact of the aging of the baby boom
generation, the necessity of addressing and reforming the health care system was not in dispute
by most political, economic and public policy observers. Despite the recognition that there
needed to be changes in the health care system, there was passionate, ideological and partisan
disagreement about what actions and changes were acceptable.
An analysis of the recurring historical pattern of attempts to reform health care and
insurance coverage showed that the issue came to the forefront of political and legislative debate
in a cyclical pattern across the entire 20th century (Berkowitz, 2008). The most recent chapter of
this repeated push for health care reform, prompted by ever increasing numbers of uninsured
Americans and ever increasing cost of health care and health insurance, culminated in the
successful passage of the Affordable Care Act (ACA) of 2010. In face of strong and persistent
opposition, the ACA continues to survive legal and political challenges and continues to move
forward with implementation of reforms.
With so much contentious debate about some of the other provisions of the ACA, there
has been relatively little focus by media and politicians on the sections of the ACA that
mandated the creation and development of Accountable Care Organizations (ACOs). Simply
3. 2
stated “the key idea is that the ACO has financial incentives to improve quality based on
predefined criteria and keep overall costs within a target budget” (Shortell, Wu, Lewis, Colla, &
Fisher, 2014, p. 1884). Summarizing the intent inherent in the inclusion of ACOs as an integral
part of reform, Devore & Champion observe that “the Affordable Care Act embraced ACOs as
one way to foster the transition from a disjointed, siloed health care system to one that is better
coordinated and aligned to provide far more value to patients, providers, and payers” (DeVore &
Champion, 2011). This paper will review the history and aims of the concept of ACOs, discuss
the provisions of the ACA related to ACOs, and consider development, significance and
performance of ACOs since the passage of the ACA in 2010.
History and aims of the ACO concept
The framework for the concept of accountable care organizations has precedents in
previous attempts to control costs through efforts such as health maintenance organizations
(HMOs) and through previous attempts to improve and integrate care such as integrated delivery
systems (IDSs).
Although similar in many respects, the function, structure, incentives and aims of these
precedents are not the same as the proposed function, structure, incentives and aims of ACOs.
In fact, the current manifestation of the Center for Medicare & Medicaid Services (CMS)
reforms under the Medicare Shared Savings Program (MSSP) mandated by the ACA, ACOs
have more kinship and direct relationship to the Physician Group Practice Demonstration Project
(PGP). The PGP was mandated by the Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000, was conducted between 2005 and 2010, and was extended for two
4. 3
additional years through 2012. The final report on the PGP, published September 2013,
discusses the lessons learned from this project related to pay for performance and quality
improvement initiatives of CMS (RTI International, 2012). The timely 2012 overlap of the
ending of the PGP with the initiation of the MSSP allowed for a continuity and flow of programs
with nearly identical aims and philosophy with regard to the evolving pay models for Medicare
reimbursement.
Prior to the passage of the ACA and the implementation by CMS of the provisions
related to ACOs Berwick, Nolan, & Whittington contended:
Improving the U.S. health care system requires simultaneous pursuit of three
aims: improving the experience of care, improving the health of populations, and
reducing per capita costs of health care. Preconditions for this include the
enrollment of an identified population, a commitment to universality for its
members, and the existence of an organization (an ‘integrator’) that accepts
responsibility for all three aims for that population. The integrator’s role includes
at least five components: partnership with individuals and families, redesign of
primary care, population health management, financial management, and macro
system integration (Berwick, Nolan, & Whittington, 2008).
The treatment these three aims as interdependent and pursued as a whole and unified strategic
purpose is essential (Berwick, Nolan, & Whittington, 2008). Furthermore, Donald Berwick, the
lead author of the above referenced article, served as Administrator of the Centers for Medicare
and Medicaid Services (CMS) from July 2010 to December 2011 through a recess appointment
by President Obama. His expressed ideas regarding the aims, intent, and potential significant
role of ACOs match the intent of the law and reveal alignment with the way that CMS and the
Department of Health and Human Services (HHS) are implementing the ACA with regard to
ACOs. Berwick noted that “the creation of ACOs is one of the first delivery-reform initiatives
that will be implemented under the [Affordable Care Act]. Its purpose is to foster change in
5. 4
patient care so as to accelerate progress toward a three-part aim: better care for individuals, better
health for populations, and slower growth in costs through improvements in care” (Berwick D.
M., 2011).
Also prior to the passage of the ACA, the proposal for Medicare to move toward this type
of “payment reform model” was expressed clearly by Elliot Fisher, director of the Center for
Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, joined
by other scholars and experts:
To succeed, health care reform must slow spending growth while improving
quality. We propose a new approach to help achieve more integrated and efficient
care by fostering local organizational accountability for quality and costs through
performance measurement and “shared savings” payment reform. The approach is
practical and feasible: it is voluntary for providers, builds on current referral
patterns, requires no change in benefits or lock-in for beneficiaries, and offers the
possibility of sustained provider incomes even as total costs are constrained. We
simulate the potential expenditure impact and show that significant Medicare
savings are possible. (Fisher, et al., 2009).
In fact they cite the use of the term “accountable care systems” by Shortell & Casalino to refer to
delivery systems that simultaneously organize “processes for improving quality” and are “held
accountable for quality and costs” (Shortell & Casalino, 2008). Over the course of just a few
years the concept of accountable care has grown dramatically in acceptance, use, and application.
Devore & Champion describe the goals and potential of ACOs in this way:
Overall, the goals of an ACO are to empower people to take charge of their health
and engage in shared decision making with providers; eliminate waste and
unnecessary spending while also meeting patients’ preferences for care; increase
preventive care and other strategies that could help keep people well; and increase
overall satisfaction with care. ACOs could also provide incentives for clinical
integration by offering financial rewards to caregivers who work cooperatively to
provide a continuum of care and achieve agreed-upon measures of success
(DeVore & Champion, 2011).
6. 5
With these ideas and proposals giving context and providing guidance to both the
formation and the implementation of the ACA, CMS summarized the three objectives of MSSP-
ACOs with the following specific description:
Better overall care in a safe environment, equitable to all who seek it, and always
available when needed.
Improved health accomplished through the practice of proactive, preventive
medicine and chronic care coordination.
Lower per capita cost aimed at reducing the trending of medical costs associated
with the Original Medicare population (often referred to as "Medicare Fee-for-
Service") (Triple Aim Objectives, 2012).
Within this broader framework of objectives CMS has focused on four key areas of emphasis for
quality standards: patient satisfaction, care coordination, preventive health, and care for chronic
illness.
The role of ACOs in the reforms of the ACA
Title III of the ACA carries the heading and contains provisions related to “Improving the
Quality and Efficiency of Health Care.” Section 3022 of Title III directed the Secretary of the
Department of Health and Human Services (HHS) to “establish a shared savings program that
promotes accountability for a patient population…and encourages investment in infrastructure
and redesigned care processes for high quality and efficient service delivery” (Patient Protection
and Affordable Care Act, 2010). Through the Medicare Shared Savings Program (MSSP)
created by HHS, eligible health care providers and suppliers serving Medicare beneficiaries who
7. 6
meet specified requirements and who agree to participate in the program must agree to be
“accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries
assigned to it” (Patient Protection and Affordable Care Act, 2010). A participating ACO is
required to “define processes to promote evidence-based medicine and patient engagement,
report on quality and cost measures, and coordinate care, such as through the use of telehealth,
remote patient monitoring, and other such enabling technologies” (Patient Protection and
Affordable Care Act, 2010). In addition to receiving the payments of the original fee-for-service
program, participating MSSP-ACOs become eligible to receive additional shared payments for a
portion of demonstrated savings. Once savings reach designated, benchmarked levels, the
created performance and practice savings are essentially “shared” by the MSSP-ACO and the
Medicare program. CMS reported the following update on the status and participation of ACO
established as part of the Medicare Shared Savings Program since the inception of this mandated
ACA program:
“Since passage of the Affordable Care Act, more than 360 Medicare ACOs have
been established, serving over 5.6 million Americans with Medicare. Medicare
ACOs are groups of providers and suppliers of services that work together to
coordinate care for the Medicare fee-for-service (FFS) beneficiaries they serve
and achieve program goals; Medicare ACOs choose a level of performance risk
and receive financial incentives based on that choice and their quality
performance” (Center for Medicare and Medicaid Services, 2014).
It is important to note that there is not simply one type or one model of ACO. In fact,
ACOs are formed and operate under different categories, use different models, and serve
different and distinct groups and populations of patients. Broadly speaking ACOs may be
formed in response to public policy and payer reforms such as has been described with MSSP.
Many are focused on primary care services, care of specialty populations, care of populations
with specific chronic diseases, Medicaid, underserved, and safety-net populations. There has
8. 7
also been observed some movement in state, commercial, and private payer programs toward
ACOs and principles intended to shift toward new health care payer models that reflect and
incorporate the goals of improved quality, better coordination of care and service, greater
engagement with patients in treatment planning and support, increased efficiency, and reduced
costs.
Although most attention has been focused on the ACOs related to the MSSP provision,
the CMS identifies other types of ACOs which are a part of the efforts and strategy of CMS.
In addition to MSSP-ACOs CMS also is working with the Pioneer ACO Model (designed for
selected integrated early participants in coordinated care models) and an Advance Payment ACO
Model (a supplementary incentive program for selected primary care, smaller, or rural providers
to provide support toward developing a model of accountable care). CMS has shown particular
focus on primary care service, prevention, management of chronic illness, specialty populations,
as well as at-risk and underserved populations. Title II Section 2706 of the ACA mandated a
Pediatric Accountable Care Organization Demonstration Project focusing on studying and
improving care for children with special medical needs. This particular project is scheduled to
run for a five year period that is set to end at the end of 2016.
Among the many types of ACOs that have developed over the past few years some are
focused on primary care, some on serving Medicare and/or Medicaid patients, some are focused
on serving specialty populations of patients with specific chronic health conditions, some are
focused on serving larger, general groups of patients and communities providing integrated
health care services across the care continuum. In addition to recently developing ACOs that are
formed around contracting with public payers such as Medicare and Medicaid programs
administered through CMS, ACOs are also developing which have established contractual
9. 8
relationship with private, commercial payers. Recent research reports indicate that
approximately half of existing ACOs had a contract with a private payer. Contracts with private
payers were usually set up as shared savings models, and most private contracts included
downside risk. This study also reported that ACOs with private contracts tended to be larger and
more complex organizations overall than the typical ACOs that did not have private contracts
(Lewis, Colla, Schpero, Shortell, & Fisher, 2014). The Accountable Care Implementation
Collaborative is a private project of the Premier healthcare alliance. Formed in 2010, this
collaborative “consists of health systems that seek to pursue accountability by forming
partnerships with private payers to evolve from fee-for-service payment models to new, value-
driven models” and to develop “best practices that can inform the implementation of accountable
care organizations as well as public policies” (DeVore & Champion, 2011).
Characteristics and taxonomies of ACOs
In attempting to understand the nature, distinctiveness, and effectives of ACOs,
researchers are beginning to classify ACOs according to particular characteristics. Following the
passage of the ACA, early observations about the development of ACOs noted the following 5
patterns:
1. Dispersion of ACOs varies by market.
2. Specific regions of the U.S. are lacking in ACOs.
3. Hospitals and hospital systems are the main backers of ACOs.
4. Investments in the ACO model exist independently of the Medicare Shared
Savings Program.
5. The success of different ACO models is still unproven.
(McNickle, 2011).
10. 9
Several research groups have conceptualized and developed specific “taxonomies” that will
allow for more precise discussion, research, and analysis regarding the organization and
performance of ACOs (Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012; Shortell, Wu,
Lewis, Colla, & Fisher, 2014; Colla, Lewis, Shortell, & Fisher, 2014; Muhlestein, Gardner,
Merrill, Petersen, & Tu, 2014). Recognizing early the rapidly shifting landscape caused by this
alternate care delivery and payment model, Fisher et al. discussed the need for a framework for
understanding, tracking, and monitoring the formation, development and performance of ACOs
(Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012). As they tracked course of early
ACOs, they identified “the major factors—such as contract characteristics; structure, capabilities,
and activities; and local context—that would be likely to influence ACO formation,
implementation, and performance” (Fisher, Shortell, Kreindler, Van Citters, & Larson, 2012).
Through devising a framework for evaluating these pioneer organizations, they hoped to be able
to provide contextual information and guidance to decision-makers and policy makers that would
contribute to the success and effectiveness of succedent ACOs (Fisher, Shortell, Kreindler, Van
Citters, & Larson, 2012).
The work of analysis and study of ACOs has continued to advance along with the rapid
increase in the number and diversification in variety of ACOs. One way that ACOs can be
differentiated is by role of physicians in the administrative leadership of the organization:
physician-led versus non-physician led ACOs (Colla, Lewis, Shortell, & Fisher, 2014). In a
recent detailed study that analyzed current numbers, structures, characteristics and functions of
ACOs, Shortell et. al. used resource dependence theory and institutional theory combined with
analysis of the following eight specific measures:
11. 10
the ACO’s size, number of different types of participating provider organizations
within the ACO (including nursing or postacute care facilities), the scope of
services offered, whether the ACO belongs to an integrated delivery system
(IDS), the percent of primary care clinicians, their institutional leadership model,
the performance management system used for accountability, and the ACO’s
prior experience with payment models other than fee-for-service (Shortell, Wu,
Lewis, Colla, & Fisher, 2014).
From their extensive research and analysis they identified “a reliable and internally valid three-
cluster” taxonomy consisting of three broad categories of ACOs: “integrated delivery system
ACOs,” “smaller, physician-led ACOs,” and “hybrid ACOs” (Shortell, Wu, Lewis, Colla, &
Fisher, 2014). Most typically integrated delivery system ACOs “offer a broad scope of services
and frequently include one or more postacute facilities;” smaller, physician-led ACOs
generally were focused on primary care service delivery and were characterized by “a relatively
high degree of physician performance management;” and hybrid ACOs tended to be a mixture or
combination of “moderate sized, joint hospital-physician and coalition-led groups that offer a
moderately broad scope of services with some involvement of postacute facilities” (Shortell, Wu,
Lewis, Colla, & Fisher, 2014). They assert that this taxonomy can serve as a valuable tool “to
describe and understand early ACO development and to provide a basis for technical assistance
and future evaluation of performance” (Shortell, Wu, Lewis, Colla, & Fisher, 2014).
Furthermore, they suggest that the taxonomy may be useful to payers and to “provider
organizations considering ACO formation by accessing how their attributes match those of the
three clusters with regard to potential strengths and weaknesses for meeting the challenges
involved” with becoming an ACO (Shortell, Wu, Lewis, Colla, & Fisher, 2014).
Leavitt Partners also published a white paper proposing a taxonomy of accountable care
organizations. This report identifies six core types of ACOs: Independent Hospital and Hospital
12. 11
Alliance ACOs (both led by hospitals), Independent Physician Group, Physician Group Alliance,
and Expanded Physician Group ACOs (led by physician groups), and Full Spectrum Integrated
ACOs (led by integrated delivery systems) (Muhlestein, Gardner, Merrill, Petersen, & Tu, 2014).
They also identified two additional attributes can overlap with these six types: decentralized
decision maker ACOs which involves multiple organizations being involved in the ACO and
contributing to the decision-making structure and processes or previously unaffiliated
organizations joining to establish a new ACO and specialty ACOs that focus on a particular type
or group of patients such as a set of patients with a particular condition, illness, or disease
(Muhlestein, Gardner, Merrill, Petersen, & Tu, 2014, p. 6). They further advocated the value of
this type of information and analysis to ACOs, providers contemplating becoming an ACO,
suppliers who serve ACOs, and payers and policy makers that study and manage ACO contracts
(Muhlestein, Gardner, Merrill, Petersen, & Tu, 2014, p. 8).
Early expectations and early indicators of performance of ACOs
In the initial period after the passage of the ACA, opinions about the likely success of
ACOs in the context of health care reform ranged across a wide spectrum from strong negativity
to skepticism, to cautious optimism, to strong enthusiasm. The provisions of the ACA dealing
with ACOs did not escape a certain share of criticism and negative commentary. Certain
analysts with a critical bias have lamented the inadequacies of the concept of ACOs and
predicted their failure to accomplish their goals. Some critics doubted the model, some doubted
the government’s capacity to manage such a shift in care delivery with positive effect, and some
doubted that the concept could produce progress in cost reductions without concurrently
sacrificing quality and patient satisfaction. Early evidence suggests that this particular concern
13. 12
may not be supported based on surveys of the initial experience and perception of patients. One
initial study of patient satisfaction comparing baseline and comparative control data found that
“patients’ experiences were improved or preserved in provider organizations participating in
ACO programs despite incentives to limit health care use” (McWilliams, Landon, & Zaslavsky,
2014).
Some critics have argued that ACOs will face the same obstacles and the same fate as
these precedent attempts to change healthcare delivery and financing in the U.S. Shi & Singh
expressed the sentiment that ACOs “may well turn out to be nothing more than ‘old wine in new
bottles’” (Shi & Singh, 2015, p. 367). By this they suggest that ACOs may simply be another
manifestation of earlier failed attempts to control costs including through development of
integrated delivery systems (Burns & Pauly, 2012). Countering the premise of this criticism and
prediction of ACOs sharing the same fate as earlier attempts of managed care, Berwick contends
“the core of the ACO idea is coordinated care with free choice for beneficiaries. I think it’s a
brilliant idea… because it pulls one of the two fangs out of managed care: loss of choice. The
other fang is skimping, and that’s going to require strong monitoring of ACOs’ performance”
(Berwick, 2012, p. 722). Although the use of ACOs to transform the payment model of
Medicare and Medicaid is not a simple, easily implemented reform attempt and is not a panacea
for our serious health care financing challenges, they do hold promise for bringing about
significant savings and simultaneous improvement in quality of care and services provided
(Berwick D. , 2012). While the longer-term success of ACOs may still be uncertain, early
evidence and indicators show promising and hopeful results regarding the experience of patients
and the costs (Greene, 2015; McWilliams, Landon, & Zaslavsky, 2014).
14. 13
With the backdrop of these predictions and in the context of passionate ideological,
political, and legal confrontation, the experience and success of ACOs have varied over the past
two years. Casalino assesses “the performance of ACOs to date has been promising but not
overwhelming” (Casalino L. , 2014). Still he acknowledges that ACOs “represent the best
attempt to date to move away from business as usual toward health care that will improve
patients’ health and will not bankrupt the country” (Casalino L. , 2014). Despite the contention
and uncertainty surrounding health care reform and the effects of these particular reforms for the
long-term, broadly and fairly considered ACOs have demonstrated some early measured positive
results in patient satisfaction, health outcomes, and cost savings. In particular, one important
population of patients, medically complex patients, “reported significantly better overall care
after the start of ACO contracts” in one study (McWilliams, Landon, & Zaslavsky, 2014). In
discussing how ACOs have performed with regard to cost savings, Perez provides a detail
specific analysis of cost savings already achieved by ACOs. As demonstrated by the results of
Medicare Shared Savings Program (MSSP) ACOs, Pioneer ACOs, Medicaid ACOs, and
Commercial ACOs, results varied for individual ACOs related to cost savings while at a macro
level results broadly showed return on investment for ACOs as providers of care and significant
cost savings for payers. Once cost savings have reached specified goals, ACOs generally benefit
financially through revenue returned form shared-savings incentives (Perez, 2014).
Specific performance results of ACOs that are part of CMS programs, including the
MSSP, are publicized regularly. In late 2014 CMS reported:
Last year, many ACOs had higher quality and better patient experience than
published benchmarks. This year, compared to previous year performance, the
ACOs improved significantly for almost all of the quality and patient experience
measures demonstrating that these organizations improve care. ACOs in the
Pioneer ACO Model and Medicare Shared Shavings Program (Shared Savings
15. 14
Program) also generated over $417 million in savings for Medicare. At the same
time, ACOs qualified for shared savings payments of $460 million. (Center for
Medicare and Medicaid Services, 2014).
The process of reform and of changing the mechanisms, financing, and culture of health care
delivery and service will be slow to change. Even if criticism comes that the reforms and
changes in the system are not enough and even if it is too early to tell what the impact and import
of broader ACA and more precise ACO reform initiative will be, there is no question that the
demonstration projects and the activity around new ACOs, both commercial and public payer
related, are cause for innovation and hope. HHS, CMS, and the recently formed Center for
Medicare and Medicaid Innovation, have demonstrated skill at assessing, listening, adapting, and
revising policies, guidelines and regulations during the development and implantation of these
reforms and projects. In efforts to continue to nurture and encourage the development of ACOs
as a part of reforms to transform health care delivery and payment models, CMS announced and
sought public comment on several proposed adjustments intended to improve the Medicare
Shared Savings Program. The categories of these proposed adjustments were “providing more
flexibility for ACOs seeking to renew their participation in the program,” “encouraging ACOs to
take on greater performance-based risk and reward,” “emphasis on primary care,” “alternative
methodologies for benchmarks,” and “streamlining data sharing and reducing administrative
burden” (Center for Medicare and Medicaid Services, 2014). These proposed adjustments are a
positive sign of a allowing for nimbleness, flexibility and setting a tone to signal current and
future ACOs that there can be an open dynamic process for negotiating and adjusting the
payment and incentive models and sensitivity to the burden of the administrative and reporting
requirements of participating ACOs.
16. 15
Despite a climate of caution and uncertainty across much of the health care system over
the past several years, the growth in number of ACOs over the past several years has been
significant. According to one monitor of ACO growth and development the number of ACOs
increased from 82 in 2011 to 626 in the summer of 2014. This report breaks down this total in
the following way: “Of these 626 ACOs, 329 have government contracts, 210 have commercial
contracts, and 74 have both government and commercial contracts. The remaining 13 ACOs
have not made specific announcements about the nature of their accountable care contracts or are
in the process of finalizing contracts that are not yet active” (Petersen, Gardner, Tu, &
Muhlestein, 2014). This report notes that this growth in ACOs means that the total number of
“ACO-covered lives” as of June 2014 was approximately 20 million (Petersen, Gardner, Tu, &
Muhlestein, 2014).
Discussion of the potential and promise of ACOs
Analyzing the current state of health care reform implementation and the likely impact of
reforms on the healthcare system, a recent Robert Wood Johnson Foundation report asserts that
“more than any other policy change in the ACA, nothing has more potential to influence the
future of nearly every health care sector than Accountable Care Organizations (ACOs)” (2015
Accountable Care Organization Outlook: Implications for Suppliers and Providers, 2014).
From a broader analysis of the potential of ACOs to have a significant and positive role
in making progress toward the triple aims of increased quality, improved health outcomes, and
reduced costs, Perez concludes that “ACOs are an aggressive, innovative means of shifting the
business of health care from the well-entrenched fee-for-service model to a fee-for-value
17. 16
approach. They are an example of practicing the art of the possible, effecting fundamental
change in a large, capitalist society where the healthcare system is a complex web of public-and
private-sector involvement” (Perez, 2014). “If ACOs succeed, they will be a critical and lasting
legacy of the Affordable Care Act” (Casalino L. P., 2014).
Conclusion
Although there is still much uncertainty about the long-term meaning and significance of
the advent of accountable care organizations as alternate way of delivering and financing health
care, there is ample evidence that this phenomenon is growing and showing signs of sustainable
viability. Describing the promise and prospects of ACOs altering the framework and landscape
of health care delivery in the United States, DeVore & Champion made the following
observation several years ago:
ACOs represent a dramatic departure from the status quo of health care delivery.
They have the potential to overcome the fragmentation and volume orientation of
the fee-for-service system so that the right incentives are in place to foster health
and wellness, instead of payment for treating illness. Unlike previous efforts
under the “managed care” rubric that were mainly designed to reduce costs, a
properly designed ACO would balance that need against the need to improve
outcomes and improve the care experience. (DeVore & Champion, 2011).
Even with all the uncertainty and stress confronting health care providers over the past few years
with the implementation of the ACA, the hope and expectations of many health policy observers
regarding ACOs has remained high. Hopefully all the stakeholders involved in providing health
care in the U.S. can go forward with a spirit of cooperation and openness to working together to
improve the efficiency and the quality of health care in the U.S.
18. 17
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