An Explanation of Accountable Care Organizations

Leading Healthcare Consultancy Answers the Three Most Frequently Asked Questions About Accountable Care Organizations and the Role of ACO Consultants in Driving Performance.

Accountable Care Organizations were formed as a result of the Affordable Care Act, which works to reduce healthcare costs. It does this through actively encouraging hospitals, doctors and other healthcare providers to form networks to coordinate patient care. ACOs also provide financial incentives when care is delivered more efficiently.

While ACOs have been making headlines, very few people understand what they are and how they work. Nationwide ACO consultants aim to educate individuals by sharing their insights into the three most frequently asked questions about ACOs.

What is an accountable care organization?

An ACO aims to share the financial and medical responsibility of offering coordinated care to patients. Made up of a network of hospitals and healthcare providers, the goal is to limit unnecessary spending. This network is built around a primary care physician who is responsible for each patient’s care.

Accountable Care Organizations seek to address the problem of disjointed treatment that lacks a full picture of the patient’s needs. This is accomplished through the development of a consistent network of healthcare providers committed to the coordinated sharing of patient information. Financial incentives further strengthen the coordinate care and dedication to reduce avoidable expenses.

Are ACOs a good option for patients?

Patients still retain full control over their treatment, so while doctors and hospitals are more likely to refer their patients to specialists within their ACO network; patients are still free to see the specialist of their choice. Patients can choose to see specialists or be referred to hospitals outside of the ACO network, and in most cases will not have to pay extra. Importantly, the patient does not have to opt-in to having their information shared within the ACO.

ACOs should make medical care more affordable for patients as there are incentives for doctors and hospitals to be more efficient and keep costs down, so providers are less likely to run unnecessary tests. The reduction of needless appointments saves patients not only time but also additional stress. In the end, the benefits produced by the ACO for both the patient and healthcare providers demonstrate their strong advantages.

How do ACO consultants help?

Top ACO consultants aim to assist individual health care providers and hospitals with ACO development and implementation. They are also able to assist with optimizing the performance of existing ACOs. This assistance can include strategic, financial, and operational support.

ACO Development

For systems in the development phase, an ACO consultant will look at, among other things:

• Risk and return
• Shared savings and division
• Investment requirements
• Development of the physician network

ACO Implementation

When it comes to ACO implementation, an ACO consultancy will assist with:

• Identifying opportunities
• Organizational structure development
• Financial structures and modelling
• Designing incentive models

ACO Optimization

ACO consultants will work with an existing ACO to help improve performance by analysing existing performance and opportunities for improvement.

They will assess costs and utilisation data related to:

• Locations
• Procedures
• Healthcare providers
• Post-care providers

Important pain points include out-of-network leakage, admissions that could have been avoided, and readmissions. They will make recommendations about what infrastructure needs strengthening, as well as engaging physicians to drive improved results.

CSuite Solutions based in Tampa, Florida, is a national strategic advisory firm that specializes in assisting Accountable Care Organizations with the development, implementation and optimization of healthcare networks.

The ACO consultancy was founded by senior health care industry executives with experience in the transformation of hospitals and other major healthcare systems into financially robust operating organizations. Their broad range of experience ensures that they are perfectly positioned to assist ACOs to perform optimally.

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