An Overview on Accountable Care Organizations

September 11, 2017

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Rajesh R. Ballakoor

Senior Manager – Client Solutions

The healthcare industry is challenged by increasing costs and discrepancies in the quality of care delivered. Conventional healthcare systems have created gaps in care delivery. In order to overcome this, Accountable Care Organizations (ACOs) have been established by Healthcare providers. The aim of these organizations is to improve care coordination between primary care physicians, hospitals, specialists, and public or private health payers. The advent of automation driven by ACO Consulting firms can go a long way in improving the efficiency of ACO operations.

ACO Consulting Services help in putting an end to traditional silos and adopt a collaborative model of care delivery. The need for such a level of collaboration and coordination has led to comprehensive Accountable Care Organization (ACO)

Managing the cost and quality of healthcare is of utmost importance for Accountable Care Organizations (ACOs). To facilitate this, Accountable Care Organization (ACO) includes payment models, and collaboration models that Healthcare systems can adopt and connect with physicians across care settings.

Accountable Care Organization (ACO) also include patient-provider communication, Clinical Data Repository, HIE Interoperability, terminology mapping and EHR Integration, patient Engagement and patient Identity Management. This helps Accountable Care Organizations (ACO) in bringing about a balance in quality, cost efficiency and overall population health.

Success of Accountable Care Organizations (ACOs) is based on efficiency, and quality of Healthcare. Bringing about any kind of improvement in productivity, quality, and cost with Accountable Care Organization (ACO) needs collaboration by adopting the right software solutions.

Accountable Care Organizations (ACO) focus on the following imperatives:

  • At-Risk Contract Management: Health care organizations majorly enter at-risk contracts without any significant understanding of their performance. This sets limits in negotiating mutually advantageous contract terms, and monitoring their performance. Therefore it becomes important for ACO leaders to know organization’s current performance standards, the trends in practice and their drivers. There are many tools that are designed to provide a detailed overview and trending information on standards to help in utilization, and measurement performance.
  • Provider Network Management: Bringing about cost efficiency is one of the main aim of Accountable Care Organizations. This requires effective identification of high cost areas and drive efforts for prioritizing them. As ACO relates to network management, it gives primary importance to getting a better insight about utilization patterns. This includes the services that are being provided from the network and the campaigns that are to be managed. Comprehensive software solutions developed by ACO Consulting firms use relevant data and support ACOs in assigning physician accountability for people served by the ACO.
  • Care Management: Healthcare services are being more customer-oriented. Therefore, after Provider Network Management, Care Management and Patient Engagement becomes next big priority. Care Management begins with identifying and developing broader patient engagement capabilities. Accountable Care Organization (ACO) help in identifying high-risk patients which further enables care team to focus effectively.
  • Performance Monitoring: Providers need to meet quality standards with their services. For this, Accountable Care Organizations identify measures that reflects performance. Suitable software tools help in monitoring, tracking and analyzing performance as per set performance measures.

Here is what makes ACOs beneficial for providers,

A milestone in achieving “value for money”:

Healthcare is dynamic in transforming ahead of times. This transformation is now changing healthcare in becoming more patient-centric and delivering service-for-fee to value-for-fee. New models for reimbursement are being developed, that are driven by quality and value served rather than quantity and volume. These emerging models include bundled payments, value-based purchasing, and Accountable Care Organizations. ACOs encourage these models to bring a true-value based delivery system in process. This leads to establishment of suitable Software processes, protocols, and infrastructure. EHR and other IT systems have helped in achieving profitability.

Going Patient-First for Patient Loyalty:

With a wide base of knowledge easily available, people are getting better informed. This has in turn paved the way for an improved quality of service and patient satisfaction. Patients now have the scope of selecting their provider by preference and not convenience. Providers therefore have an increased focus on quality, safety, satisfaction, and value. This development puts patients as the primary priority and helps providers in earning their trust and loyalty. Since patients are voicing their opinions and rating recommendations on social platforms, the earned trust can help Providers turn into stronger brands.

Profitability for Providers:

Profits in ACOs is a result of efforts based on coordination in healthcare services. To be successful, ACO services need to be efficient, quality oriented and cost efficient.

Accountable Care Organizations (ACOs) make healthcare accessible and offer better quality care at a reduced cost. Thus, the payers as well as the healthcare industry for controlling wastage in the Healthcare system. It utilizes EHR and other IT systems to trim down the amount of paperwork required to be completed. With the help of IT solutions, ACOs develop and adopt appropriate revenue model for efficiency for effectiveness. This facilitates improvement in coordination and therefore delivers comprehensive healthcare.

If you would like to know more about our Accountable Care Solutions, then do leave an enquiry with us and we will get back to you.

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