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

  • The New Business Of Healthcare
    11/26/2013

    Let’s face it. Healthcare as an industry is in a tizzy right now. With health insurance exchanges making headlines, providers looking for new ways to keep current patients and attract new ones, payers doing their best to adjust to last-minute regulations, and patients scrambling to make sense of it all, it is a wild time to be in this industry. By Cynthia Porter, president, Porter Research

  • Implementation Provides Decision Support At Point Of Care
    11/27/2013

    Einstein Medical Center’s implementation of radiology decision support system expected to reduce unnecessary radiation exposure and costs By Wendy Grafius, contributing writer

  • ACA Disrupting Doctor-Patient Relationship
    11/27/2013

    Survey shows three of four doctors feel the Affordable Care Act will increase the cost of healthcare, more than half support its repeal. By Katie Wike, contributing writer

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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