Health Payers and Providers Ease into the Era of Accountable Care
A funny thing is happening on the way to health reform; the business of healthcare in the US is gradually coming of age. Although not without its share of trials and challenges, a developing trend of comprehensive outcomes-based models are now shedding light on age-old issues like care delivery and payment structures.
These new “shared savings” models, which in the most basic explanations are simplified as “pay for treatment quality vs. quantity,” aim to motivate providers who voluntarily differentiate themselves by shifting focus to improving patient care while reducing avoidable costs over time, and away from being solely incentivized on a fee-for-service basis. The models, including Accountable Care Organizations (ACO), Patient Centered Medical Homes (PCMH), and Programs of All-Inclusive Care for the Elderly (PACE), offer the potential for transformational change through connected health. They each subscribe to the concept that coordination of all available resources will keep the patient as healthy as possible while significantly bolstering efficiency and strengthening the physician-patient relationship
The ACO model, for example, establishes a team of primary care physicians, specialists, and hospitals that ensure patients receive the right care at the right time while reducing acute episodes, avoiding unnecessary duplication of services, and preventing medical errors that often result from miscommunication between providers. Then, any resulting savings are shared among each of the participants, so long as pre-established benchmarks for quality are achieved.
In order to deliver such measurable results, however, it is imperative that all stakeholders share clinical and case management data for better informed decision making. Coordination of comprehensive healthcare services across the care continuum, particularly for chronically ill patients, must also be implemented. To that end, the Affordable Care Act (ACA) of 2010 authorizes Medicare to contract with ACOs in a Medicare Shared Savings Program.
Adobe recently sponsored the 2012 Accountable Care and Health IT Summit in Miami to facilitate open dialogue and explore the technology requirements for delivering on such an innovative concept.
The summit provided a dynamic forum for policy makers, leading Health IT strategists, and ACO early adopters to share critical insights into the process automation and integration of clinical documentation, financial systems, and payment workflows across multiple digital channels.
We extend thanks to all who attended and contributed to making the summit an overwhelming success. As always, we’re interested in your perspective. Tell us how your agency or organization is preparing for the era of Accountable Care.