According to Shortell, Casalino, and Fisher (2010), ACO is the health care association defined by the payment and care deliverance representations, which find a tie to the giver of health services through some repayment on observing quality health services with an aim of minimizing the overall cost of health care services in the involved population of patients.
ACO in Abington Health in Pennsylvania
Integrated Delivery Systems
Since the ACO program is flexible, there are various ways of organizing it. In this study, the ACO organization considered is the ACO program in Abington Health. The Abington Hospital has an integrated delivery system characterized by the collaboration of the Independence Blue Cross insurance firm, the Abington Health, and the Lumeris (Hagland, 2013).
In this collaboration, Abington Health acts as the provider of services to the population of the patients (Hagland, 2013). Its medical personnel interacts with the new machinery provided by the Lumeris to enable around-the-clock monitoring of the patient care provision (Independence, 2013). Moreover, they track the medical data beyond the patient record in the hospital to other examinations on the patient provided by other medical givers through the provided instant networks. Besides, they conduct consultation on the behalf of the other partner parties and inform the collaborating entities on the transformational opportunities (Hagland, 2013). Hence, the occurrence of adequate disease prediction especially the chronic conditions, joint patient-to-doctor practices of controlling the disease, and adequate provision of resources of managing the condition (Independence, 2013).
On the other hand, the Independence Blue Cross acts as an insurance organization that supports health care accountability through a model called the Integrated Provider Performance Imitative Plan (IPPIP) (Hagland, 2013). This is an incentive program for rewarding the doctors and the hospital in providing the best quality, well-matched, and effective health care. The incentives are given based on how the Lumeris and Independence Blue Cross evaluate the performance of Abington Health and its medical personnel (Independence, 2013).
Lastly, Lumeris provides other transformative machinery through combining its cloud-based Accountable Delivery System Platform to the Independence Blue Cross informatics and the Abington Health electronic medical records to advance service in the Abington Health through enhancing harmonization of patients, reducing the cost of meeting health care, and improving the satisfaction of service to patients by the medical personnel (Independence, 2013). For instance, Lumeris has installed NaviNet which is the safest and widely used network whenever physicians are communicating.
Paying for ACO
The used method of paying in the studied ACO is the bundle payment method, which employs several modes of payment to the participant who is ranked in four models. Model 1 includes payment for the critical hospital admissions only, model 2 comprises of doctor attendance and usage of hospital facilities for acute hospital admissions, model 3 consists of doctors attendance and usage of hospital facilities, and model 4 consists of the acute hospital admission and service attendance after acute hospital admission (CMS.gov, 2013).
All of the above models have traits. That is, the parties involved define the model in which they will participate. For instance, in model 1, all the admitted patients must choose this model but in the other unselected models the participating provider specifies the model the patient is to be included in. Moreover, the models above are defined by the services provided during the bundled payment. Lastly, after choosing the option, the patient participation in the program is not evitable and the doctor providing the medical services is never supposed to bar a selected patient from participating (Lazerow, 2013).
Payments Distribution among the ACO Providers
The bundle discount is a method of one-time saving. No later savings occur as the service provider is remunerated through the amount given as the fixed bundle payment. Those applying for the program have to make a discount to the Centers for Medicare and Medicaid Services of at least the average payment expected if the patient had paid through the free-to-free service provider (Lazerow, 2013). The amount paid is used by the Centers for Medicare and Medicaid Services when allocating the patient to one of the above models. Moreover, the amount will be used in reconciling For-Free-Service remuneration to service providers under model 1 to 3, and in model 4, the amount pays the contracting body (CMS.gov, 2013). In case the paid discounts surpass the For-Free-Service reimbursement, the examination providers keep the excess. Hence, this ensures the service giver does not offer superfluous services and allows the providers to diminish charges without dropping their proceeds (Lazerow, 2013).
In addition, the bundle discount method allows gains sharing between the service provider and the hospital since after saving the costs, the Centers for Medicare and Medicaid Services waives some payment on regulations governing the health facility. The gain-sharing process is voluntary, the company must keep the record and the provider must meet professional requirements (Lazerow, 2013).
Quality Measures to Evaluate this ACO Performance
This plan, which rewards the doctor and the participating hospital for reduced rates of readmission and hospital-attained diseases incidents, observes the evidence-based methods of treatment after attending a patient who is a member of the Independence Blue Cross IPPIP program (Independence, 2013).
As a result, the income the hospital is supposed to submit to the Centers for Medicare and Medicaid Services is determined through various methods (Lazerow, 2013). The methods include the annual presentation of the hospital records from the Inpatient Prospective Payment System and Outpatient Prospective Payment System and the constant updating of these methods for reporting quality and joint participation of providers in quality reporting inventiveness. To avoid confusion, the participant is restricted from participating in several shared-saving programs by the law (Wilde, 2012).
Conclusion
There are various reasons why the patients choice of provider and care access will not be limited by ACO. For instance, the new method of remuneration facilitates innovations without unsettling the business representation of the hospital. It removes the old system of paying for health care by charging a fee at every service delivered leading to reduced funds wastage by the patients when they are spending on the hospital. Hence, the new system is also liable for the implementation of unnecessary procedures in the name of providing efficient and worthy care (Lazerow, 2013).
Furthermore, the ACO premises are becoming more improved and accommodating in their service delivery (Wilde, 2012). The ACO receivers are not allowed to register membership with ACO. However, the service givers can become ACO members. It, therefore, gives the receiver of service flexibility of attending various service providers.
Finally, the ACO allows gains sharing between the service providers with the other collaborating entities when the cost of care charged to the participant is lower than anticipated. However, the situation of dominance must be run by the clinicians but not insurers to ensure a high level of clearness and eminent performance (Wilde, 2012).
References
CMS.gov (2013). Bundled payment for care improvement (BPCI) initiative: General Information. Web.
Hagland, M. (2013). A Pennsylvania-based health plan engages with its provider through an analytics platform. Health informatics. Web.
Independence (2013). Independence Blue Cross, Abington Health, Lumeris creates a leading Accountable Care Initiative to improve the quality, low cost, increases satisfaction. [Press release]. Web.
Lazerow, R. (2013). Bundled Payment a stepping-stone for ACOs? I do not buy it. Web.
Shortell, S. M., Casalino, L. P. & Fisher, E. S. (2010). How centre for Medicare and Medicaid innovation should test accountable care organizations. Health Affairs, 29 (7), 1293-98.
Wilde, M. A. (2012). Can accountable organizations improve health care while reducing cost? The Wall Street Journal. Web.