Accountable Care Organization, Healthcare Big Data, Healthcare Portal, and ACO Implementation Resources Accountable Care Organization, Healthcare Big Data, Healthcare Portal, and ACO Implementation Resources

FEATURED ARTICLES: ACO

  • Privacy, Security, HIPAA Compliance And A $5 Billion Crime Scheme
    10/17/2014

    Utter the acronym HIPAA to people in the medical profession and you will get a variety of facial responses, none of which have been, in my experience, a smile of contentment. Indeed, HIPAA’s privacy and security rules are often grumbled about as being burdensome and restrictive. The rules are increasingly criticized as ineffective these days and people are asking: How can an entity be HIPAA compliant and still suffer a breach of protected health information? By Stephen Cobb, Senior Security Researcher, ESET

  • HIMSS12 & Stage 2 MU: A Match Made In Vegas
    3/1/2012

    HIMSS12 proved to be the biggest HIMSS yet as more than 37,000 healthcare executives, IT professionals, and clinical leaders flocked to Las Vegas to attend valuable health IT educational sessions and evaluate the latest products and services from more than 1,100 vendors in the exhibit hall. By Ken Congdon, Editor In Chief, Health IT Outcomes

  • ACOs: Healthcare’s Future, Or An Inevitable Failure?
    4/2/2013

    The term Accountable Care Organization has been around since 2006 and, in 2009, became part of the healthcare industry landscape when it was included in the Patient Protection and Affordable Care Act. BerylHealth created this infographic which provides a wealth of ACO-related information from the amount of the U.S. GDP spent on healthcare (15%) to the number of quality measures ACOs are measured on (33). By John Oncea, editor, Health IT Outcomes

CASE STUDIES & WHITE PAPERS

FROM THE EDITOR'S DESK

  • The Problem With Consumerism In Healthcare

    Many industry leaders championed a free market approach to healthcare during the 12th Annual World Health Care Congress last week. Here are a few key reasons why I don’t think this model is “the fix” our industry so desperately needs.

ABOUT ACCOUNTABLE CARE ORGANIZATIONS (ACO)

An Accountable Care Organization (ACO) utilizes a payment and care delivery system that bases payments to providers on quality metrics and seeks to reduce the total cost of care for a certain population of patients.  ACOs use a range of payment models and consist of groups of coordinated healthcare providers that provide care to groups of patients. ACOs are accountable to a third-party payer and the group of patients for the appropriateness, quality, and efficiency of the health services they provide.

In 2011, the Department of Health and Human Services (DHHS) set forth initial guidelines for ACOs to be created under the Medicare Shared Savings Program. These guidelines contained all necessary steps required for a physician, health care provider, or hospital to voluntarily participate in ACOs.

The quality measures used to evaluate an ACO's performance as defined by the Center for Medicare and Medicaid Services (CMS) fall into five domains. These domains are patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.

The three stakeholders in an ACO are the providers, payers, and patients. Providers are a network of hospitals, physicians, and other healthcare professionals. The primary payer is the federal government, Medicare, but also includes other payers such as private insurances or employee-purchased insurance. The patient population of an ACO will primarily consist of Medicare beneficiaries, but in larger ACOs can also include those who are homeless and uninsured.

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