According to a study by the Centre for Medicare and Medicaid Services (CMS) in 2009, healthcare costs have been growing at an unsustainable rate, reaching an estimated 17.3% of the gross domestic product (GDP) in 2009. This represents the largest one-year increase in the history of the United States. The CMS further predicts that if left unchecked, these costs could rise to 19.3% by 2019, almost one fifth of the nation’s GDP. The current healthcare system needs measures that will allow quality healthcare for all Americans at more affordable costs, a system that measures quality improvement through coordination and cooperation between health care providers.
The Accountable Care Organizations Program
On March 31, 2011, the Department of Health and Human Services (HHS) proposed new rules to help doctors, hospitals and other healthcare providers coordinate better for Medicare patients through Accountable Care Organizations. Federal officials estimate that the program could save Medicare up to $1.1 billion over 5 years and would provide a strong base for better and cost effective healthcare facilities for all.
Accountable care organizations are a group of doctors, hospitals and healthcare providers who come together voluntarily to provide high quality care to Medicare patients. According to the law, an ACO should agree to manage the healthcare needs of at least 5000 Medicare beneficiaries over a period of three years keeping the quality improvement metrics and common data management in mind. For ACOs to work, they will have to follow the principle of information sharing to cut down on costs, and those who will help in cost reduction get to keep a part of the savings.
How will ACOs Change the Face of the Healthcare Industry?
According to a survey, more than half of the Medicare beneficiaries in the US suffer from chronic ailments (heart diseases, kidney diseases, etc). These patients receive care from multiple physicians, which can result in duplication of care or even medical errors, if the information is not shared seamlessly between the different practitioners. Not only does this reduce the quality of healthcare but also increases healthcare expenditures. ACOs have evolved to bridge this gap and provide the same quality of healthcare within the same costs to one and all. Some of the primary benefits of Accountable Care Organizations include:
• Coordinated care with the help of doctors, hospitals and practitioners: All ACO members can share their best practices and experience to improve the standards of healthcare.
• Data collection and analysis to continuously improve performance: Automation of the process, including personal health care records, will help analyse progress. Also, the data gathered will act as a tool for information sharing between different practitioners.
• Costs reduction: ACOs will create saving incentives by offering bonuses when providers keep the costs down and meet the quality standards, focusing on prevention. So healthcare providers will get more money for keeping their patients healthy, which consequently would cut down on healthcare expenditure.
ACOs will not only help in improving the communication between physicians but in continuous performance tracking, resulting in better healthcare facilities.
Role of Information Technology
Information technology plays a major role in this revolution. IT not only aids in creating personal health records and data management for information sharing purposes but also helps in transferring patient summary and discharge reports between different practitioners. Here are some of the major advantages that IT solutions offer:
• Electronic health records: Information technology aids in maintaining personal health records of patients, including their care related transactions and provides framework for the ACO to determine the quality of care provided to the patient.
• Centralized data management: Helps in transferring patient data from one practitioner to another and identifying areas where performance can be improved.
• Detecting high risk patients: Using information technology we can predict high risk patients and provide them extra care with focused care resources.
The concept of ACOs is still new and many experts feel that ACOs could run afoul of anti-fraud and anti-trust laws. However, those seeing the brighter light have an entirely different vision in sight. According to experts who support the evolution, ACOs, coupled with advancements in IT, could very soon change the face of the healthcare sector for the better.