How Accountable Care Organizations Improve Health Care for Patients
News In a recent study from the American Medical Association, accountable care organizations that treat Medicare beneficiaries on average are able to save an estimated $136 per patient annually.
Across the country, doctors and hospitals are forming networks called accountable care organizations (ACOs) to deliver more efficient and coordinated health care that puts patients at the center of their care to keep them healthy. ACOs reward doctors and hospitals that deliver high-quality care while keeping costs down.
ACOs rapidly continue to expand. Around 800 exist in the United States, treating an estimated 28 million people. Almost 9 million of those lives are enrolled in Medicare.
How they work
ACOs seek to be the patient’s hub for health care. The goal of an ACO is coordinating care for their patients, from routine checkups to various specialty provider visits to hospital stays and follow-up care. Primary care physicians, such as an internist, family physician or general practitioner provide a guiding hand through the patient’s care and treatment.
When providers have this involvement in the “care continuum,” they get a more complete knowledge of the patient and deliver the most effective treatment. This coordination can prevent costly emergency room visits or duplicative or unnecessary tests and can increase patient safety by perhaps flagging a drug allergy or preexisting condition. Also, by emphasizing primary care and overall health, a condition can be prevented before it must be treated.
“When providers have this involvement in the ‘care continuum,’ they get a more complete knowledge of the patient and deliver the most effective treatment.”
To determine ACO value, ACOs are given a set of quality standards they must meet, as well as a financial benchmark — or amount of money expected to be spent on each patient. The Centers for Medicare and Medicaid Services measures quality of care using nationally recognized measures in four key areas: patient experience, care coordination or patient safety, preventive health and at-risk population. If the ACO provides the appropriate quality of care and attains financial efficiencies, it keeps a portion of the savings achieved.
Those savings are even higher when just looking at sicker patients, with savings increasing to $456 per patient annually for those patients with three or more conditions. Part of these savings are generated from reduced visits to the emergency room and fewer hospitalizations.
The Centers for Medicare and Medicaid Services reports that quality scores for Medicare ACOs continue to improve every year. Measurable improvement has been demonstrated in patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, screening for tobacco use and cessation, screening for high blood pressure and use of electronic health records.
ACOs provide a valuable option for how health care is delivered, as proven by the ever-growing enrollment.