The Promise of Accountable Care

By Shannon Huggins
Vice President, Managed Care
Methodist Health System

Sometimes, the ABCs of health care can be confusing. But in the new world of health care reform, there’s one acronym that everyone needs to know — ACO. ACO stands for accountable care organization. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is a group of doctors, hospitals, and other health care providers who work together to provide patients with better, more coordinated care. The providers who participate in an ACO — hospitals, physicians, and post acute-care organizations — generally care for a patient population of at least 5,000 lives, thus the growing interest in population health management.

Theoretically, an ACO turns the health care system on its head by changing the focus from pay-for-volume (fee-for-service medicine) to pay-for-performance (outcomes-based medicine). Improved health should result from collaboration, coordination, and information-sharing among all providers involved in each patient’s entire episode of care.

Why has this new payment model emerged as the primary vehicle for future health care delivery? One word comes to mind — money. The fact is, the current model is a significant contributor to the nation’s debt worries, with some experts forecasting that the Medicare Trust Fund will exhaust its financial resources within a few years.

On July 1, 2012, the Methodist Patient-Centered Accountable Care Organization (MPCACO) was selected to participate as an accountable care organization in the Medicare Shared Savings Program, a multifaceted new program sponsored by CMS. More than 200 physicians are partnering in the MPCACO.

Through the Shared Savings Program, MPCACO is working with CMS to provide traditional Medicare beneficiaries with enhanced care coordination designed to provide them the right care, at the right time, and in the right setting.  It’s a proactive model, rewarding the hospital when a beneficiary can avoid a visit to the emergency room or hospital. And, with 13,000 people in the ACO, it’s no small feat!

Changing the patient experience will require delivering care in new, innovative ways. Error-free handoffs and transitions accomplished via improved communication are at the heart of the new care delivery model. For inpatient nurses, that’s important because he or she will now know that when patients leave their care in the hospital, they will continue to receive needed care throughout the year.

Providers participating in ACOs are approaching them in different ways, depending on where they started the journey. ACOs will shine the light on the serious problem of shortages of health care professionals, especially with nurses, case managers, and social workers. Caregivers will have more information on their patients before they come to the hospital, enabling caregivers to engage at a higher level and create more cost-effective, seamless care.

MPCACO is physician-led, and Methodist is assisting MPCACO in its efforts to provide those physicians with tools to better coordinate the work that they do. MPCACO has engaged Methodist to hire support staff, including care navigators and social workers. And MPCACO, with Methodist’s help, is analyzing our data and the data from CMS to produce predictive models that will help maximize resources.

If you’re ready to improve the care that you provide to patients with an organization that’s participating in the future of health care today, then it’s time to choose Methodist Health System. Learn more by visiting Jobs.MethodistHealthSystem.org.

© Methodist Health System

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