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

  • Is Advertising The Answer For Cutting EHR Costs?

    With rising costs surrounding EHR software and fees, providers are turning to services that display advertisements as a way to save money By Katie Wike, contributing writer

  • New Population Health Decision System For ACOs Uncovers The Hidden Risks

    One of the biggest challenges for Accountable Care Organizations is effective deployment of patient care resources. To succeed requires an in-depth understanding of patient risk, which is often difficult to assess. The reason for this is that most risk analysis systems rely on claims data, which can only tell who, in the past, has been a high-use patient. What that data can’t do is tell you who is on the verge of developing a serious condition.

  • Guest Column: The Interoperability Playbook: A Winning Plan To Conquer Meaningful Use This article provides expert advice on how hospital CIOs can build and tailor a framework for hospital interoperability and meaningful use using clinical data and document exchange technologies. By Rey Currie, Global Director, Product Management, Lawson Software
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CASE STUDIES & WHITE PAPERS

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FROM THE EDITOR'S DESK

  • The Problem With Consumerism In Healthcare
    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.

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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.