Can Accountable Care Organizations Revolutionize the Health Care System?

In recent years, the steady increase of health care spending has become a top issue for patients, employers and politicians alike. The problem goes beyond the inconvenience of making more room in your personal budget — it’s the concern that steep health costs may hinder access to quality care, compounding future risks and expenses.

The creation of accountable care organizations (or ACOs) is one response to this issue. By focusing on serving patient needs and proving effective outcomes, ACO health care models have the potential to help change the health care system for the better.

Here’s what you need to know about ACOs and how they can benefit your employees and your business.

What Are Accountable Care Organizations?

An ACO is a group of doctors and hospitals that shares responsibility — financial and medical — for providing coordinated care to patients. The ACO model puts a primary care physician at the center of each patient’s care. This centralized authority helps manage the patient’s wider team of providers, streamlining care by ensuring that everyone has the same information, setting up the right treatments at the right times and avoiding unnecessary services or errors.

How Do ACOs Help Manage the Cost of Care?

ACOs originated around the implementation of the Affordable Care Act with the aim of reducing unnecessary health care spending. Along with setting up a system designed to prevent unwanted gaps or overlaps in care, the ACO model helps control costs by tying payment to patient health outcomes, incentivizing providers to be more “accountable.”

This type of value-based care is intended to encourage more preventive care as well as reduce costly hospital stays and emergency room visits.

Who Benefits From the ACO Model?

Of course, providers and hospitals have the potential to benefit from ACO setups by receiving monetary incentives based on the results they deliver. But there’s no doubt that employees and employers can also benefit from this network approach.

When employees receive care that’s coordinated around the primary goal of maximizing outcomes, they end up needing to devote less time and money to maintaining their health. Because information is shared among providers, patients in ACOs fill out fewer forms and take (and pay for) fewer tests. They also have access to a wider network of providers than they would with an HMO.

For employers, the efficiency and results orientation of ACO health care translates into lower insurance costs and, at the end of the day, a more present and productive workforce.

How Do You Know If an ACO Plan Is Right for You?

As employers continually scrutinize the relationship between employee health and the bottom line, ACOs have risen as one potentially promising option for improving benefits while minimizing costs.

Still, deciding whether an ACO plan will provide more value than your current one isn’t simple. The National Business Group on Health (NBGH) offers both an ACO Journey Map and a Scoring Guide to help you weigh your ACO options. The Journey Map is a useful tool for evaluating an ACO at different stages of its development based on critical factors and competencies beyond simple cost data, from the ACO’s clinical responsibilities, its network of providers and its care model to the consumer experience it offers, its technology and its finance model.

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Since the ACO concept is relatively new, many organizations are still in the maturation process. As you examine your options, use the tools above to help you ask the questions that will determine whether an ACO will meet the needs of your business and your employees. Grasping those needs — and your current plan’s value — is a crucial first step, so don’t let the promise of the ACO model lure you into skipping ahead.

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This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.

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