Health care delivery has evolved in the past few years along with the demand of new medical technologies and more sophisticated treatment options. However, lapses in quality as well as skyrocketing costs have resulted to a number of negative responses from the general public. This in turn paved the way for an increase in new health care organizational models whose aim is towards the improvement of coordination as well as efficiency of health care delivery. It led the way towards the inception of accountable care organizations.

The Accountable Care Organization (ACO): Its Goals And Significance

The ACO has the ultimate goal of improving coordination among physicians, nurse practitioners, hospitals and other health care providers. An integrated medical group is identified as an organization within an ACO which is held accountable for care coordination, quality and efficiency.

There are at least 3 characteristics of an ACO and these are:

• Ability towards patient management and provision as well as care continuity across various institutional settings. This includes ambulatory and in patient hospital care and post acute care.

• Capability of planning budgets and resource needs.

• Sufficient size to support comprehensive, valid and reliable performance measurement (Berenson).

Owing to this the ACO can act as a reform tool for incentivizing more efficient and effective health care. The ACO can also help combat overutilization and overbuilding of health care facilities and technology.

Accountable Care Organization Models

Some types of practice arrangements which can serve as ACO models are the following:

1.  Integrated delivery systems – These involves common ownership of hospitals, physician practices and even an insurance plan. It is characterized to have aligned financial incentives, electronic health records and resources to support cost effective care.

2. Multispecialty group practices- These usually own or have affiliations with hospitals such as the Mayo Clinic. They do not have health plans but have contracts with multiple health plans in their area and are identified to have strong physician leadership and developed mechanisms that provide coordinated clinical care.

3. Physician-Hospital Organizations – These are subsets of a hospital’s medical staff. Some function like multi specialty group practices that focus on reorganization of care delivery to achieve cost effective coordination.

4. Independent practice associations – These are individual physician practices that come together for the purpose of contracting with health plans. Most of these evolve to network of practices that engage in practice redesign and implementation of electronic health records among others.

5. Virtual Physician Organizations- These are small, independent physician practices mostly in rural areas which come together to form virtual physician organizations such as the Community Care of North Carolina. They can provide resources, leadership and infrastructure to aid practices in developing disease registries, implement electronic health records and provide better coordinated health care among others.

The Need for Accountable Care Organizations (ACO’s)

More and more federal governments especially in developed countries are encouraging the creation of ACO’s among its medical and health care institutions. Health care reform legislations are currently placed in proper order towards an ACO care delivery. Just some of the stipulated requirements of an ACO as mandated by the government are as follows:

• Accountability for overall care which includes quality and cost of assigned Medicare beneficiaries.

• Implementation of legal, leadership and management structures to support necessary payments, treatment and administrative systems among others.

• Adequate participation of primary care physicians

• Promotion of evidence based machine

• Coordination of care using remote patient monitoring and telehealth among others.

• Commitment to patient centeredness and patient engagement promotion.

There is also a call for change in payment schemes with ACO’S. It involves a process wherein ACO’s receive fixed payment often based on patient condition on a per patient basis for an agreed interval of time. The payment structure gives incentives to providers towards patient care coordination as well as cost reduction. It is a well-acknowledged fact that ACO’s take on a more active role especially because health care costs and quality pressures are more significant in recent years as compared to how it is a few years back.

Technology And Its Role in Accountable Care Organizations (ACO’s)

ACO’s cannot function effectively towards optimal health care delivery without the aid of technology. It therefore finds great use in harnessing the power of information technology and other related resources.  Health Information Technology (HIT), for one, plays a very vital role towards the efficiency and success of ACO’s. According to Dr. Sharma, CEO of 4Medica, the key part of HIT is to be able to create clinical integration of data across multiple locations between physicians, hospitals and specialists.  The CEO also stressed that with ACO’s patient information has become more patient centric with great aid from HIT.

Some health information technologies and its branches include in most part, the following:

• Electronic health records

• Data management

• Personal health records

• Health information exchanges

Data is said to be the most important ACO information technology asset. An ACO’s performance is gravely hindered if data is of poor quality even though clinicians utilize sophisticated electronic health records.