Accountable Care Case Assignment

Accountable Care Case Assignment

Accountable Care Case Assignment

“Managed Care.” MedlinePlus, U.S. National Library of Medicine, 25 Sept. 2017, medlineplus.gov/managedcare.html.

“What Is an ACO? Definitive Guide: Accountable Care Organizations.” Health Catalyst, Health Catalyst, 24 Oct. 2017, www.healthcatalyst.com/what-is-an-ACO-definitive-guide-accountable-care-organizations.

Student 2 Kpanbu

Health care spending is the biggest drive for formulating the different kinds of payment systems in healthcare. Health care insurance enrollees may obtain care from various Managed Care Organizations (MCOs) or Accountable Care Organizations (ACOs).

Managed Care Organizations (MCOs): is a group of people working together to manage the cost of health care.  MCOs work along with medical facilities and health care providers to render support to MCO patients. MCOs only pays for the care provided and its plan is not as flexible as ACOs. MCOs give incentives to physicians like the ACOs. There are four types of MCOs: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), and Point-of-Service Plan (POS).  According to (Andrews, 2014), HMOs only pay within network health care and insurers need a referral to seek care from a specialist or else the services provider will not be covered. For PPOs, care is covered both in and out of the network, however; the patient pays a higher premium for out of network care.  In EPO, care is not covered outside of the network, nevertheless; patients do not require referral to get seen by a specialist.  In POS, plan varies between HMOs and PPOs, and insurers may seek out of network care but with a higher cost-sharing rate. PPO and HMO both have Medicare options.

Accountable Care Organizations (ACOs): is a number of individuals that consist of health care providers and health care settings, collectively working together to accomplish the goal of improving optimum quality of health care. This network of people may include physicians, surgeons, pharmacists, doctors, nurses, healthcare assistants, caregivers, lab specialists, psychiatrists, mental health professionals, rehabilitation workers, other healthcare specialties and hospitals. This group of people collaboratively work together to coordinate patient care to obtain maximum care for clients and the group “accepts joint responsibility for health care spending and quality for a defined population of patients” (Song, 2014).  According to Song (2014), the three key characteristics of the ACO are: “joint accountability,” accountability for both quality of care and health care spending, and the ACO is responsible for the care of a population of people.” In the ACO plan patients have more freedom to choose the type of care within a restricted time period.  ACO provides a variety of payment structures and incentives to health care providers and hospitals primarily focusing on quality of care and financial risks to hospitals and physicians. ACO reward health care providers for the quality of care provided to patients, while eliminating irrelevant spending. ACOs do not focus on profit, but the quality of care while MCOs focus on profit.

References:

Andrews, M. (2014). What’s the best health plan for you? HMO, PPO, EPO or POS? Retrieved from https://www.washingtonpost.com/national/health-science/whats-the-best-health-plan-for-you-hmo-ppo-epo-or-pos/2014/08/25/772f96a8-27c1-11e4-958c-268a320a60ce_story.html?utm_term=.51bd23ba540e

Humana. (n.d.). HMO vs. PPO: Which one is right for you? Retrieved from  https://www.humana.com/all-products/understanding-insurance/hmo-vs-ppo

Song, Z. (2014). Accountable Care Organizations in the U.S. Health Care System. J Clin Outcomes Manag. 2014 Aug 1; 21(8): 364–371.