ACO Definition and Challenges: Accountable Care Organization(s)
Health care is the most complex, knowledge-driven industry in the world, representing one of our most significant economic challenges. While the transition to a system of more accountable care will be evolutionary, real challenges exist in building successful accountable care organizations or supporting ACO-like operations. One core challenge will be the diversity of forms of ACOs; the Centers for Medicare & Medicaid Services definition will be one of many.
What lies ahead is the reorientation of decades of organizational processes and structures that long have supported fee-for-service payments, competition among providers, and strained relationships with payers. We are embarking on a transformation of epic proportions, one that requires the industry to come together with a common purpose. We need a laser focus on care coordination, quality improvement and cost reduction.
A key tenet of accountable care is to improve integration. ACOs are expected to implement a wide range of managerial, legal, clinical and other leadership structures. The goal is to ensure that the health and wellness of the population health is coordinated, the most cost-effective care is provided, clinical processes are streamlined and follow the best evidence, the necessary reporting is in place, and the payments and reimbursement are appropriate.
Last but not least, the ACO must demonstrate, in a variety of ways, its commitment to being patient-centered and to engaging patients in coordinating their care and overall health.
We are a network of individual practices of ACO professionals.
Accountable Care will require industry perspectives and health care delivery practices to shift:
Additionally, accountability will bring new performance and utilization risks to providers, as the focus shifts from optimizing business unit performance to optimizing
network performance. At the same time, instead of maximizing the profitability of care, organizations will increase the volume of desired bundled episodes while controlling costs.
The Transformation Process...
As providers assess their risk tolerance, they must also strengthen their ability to coordinate several core processes in an accountable care environment. These core processes include