Accountable Care Organizations: These Are Not PHOs Version 2.0
The Facts
Both the House health reform bill, H.R. 3962 (Affordable Health Care for America Act), and the Senate version (Patient Protection and Affordable Care Act), include provisions (House Section 1301 and Senate Section 3022) establishing Accountable Care Organizations (ACOs). ACOs are provider-centric organizations focused on the costs and quality of care received by a designated population of patients over time. ACOs can consist of vertically and horizontally positioned providers, including physician groups and hospitals. In its most basic concept, although paid on a fee-for-service basis, ACOs that meet quality-of-care targets and reduce the aggregate costs of care rendered to their patient population relative to a spending benchmark are rewarded with a share of the savings they achieve for the Medicare program.
What’s at Stake
Regardless of whether health reform legislation is passed, providers will be increasingly challenged to adopt operating models through which they are responsible and accountable for the quality, cost and overall care of a defined population of patients. Emphasis will be placed on clinical processes and outcomes, the patient care experience and utilization.
Steps to Consider
- Evaluate why and assess those actions necessary to migrate from a financially driven model to a clinically integrated driven model if you previously operated a Physician Hospital Organization (PHO) that did not succeed.
- Evaluate investments in infrastructure and redesigned care processes for high quality and efficient service delivery.
- Establish appropriate committees to explore and evaluate adoption of clinical best practices.
- Bolster capabilities to capture and report on quality measures.
- Coordinate with other providers to facilitate the sharing of effective strategies on quality improvement, care coordination and efficiency.
- Assess hospital-physician relationships and your ability to promote and sustain quality based initiatives.
