What Are ACOs? (And How They Affect Your Company’s Health Benefits)

admin | August 14, 2019

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Question: What Are ACOS?

ANSWER: ACOs or “Accountable Care Organizations” are a payment and delivery system comprised of networks of specialists, hospitals, physicians, surgeons, and pharmacies that collaborate to provide coordinated care for a patient population.

This approach makes improving quality of care while simultaneously lowering the total cost of care (TCOC) possible by eliminating unnecessary tests, procedures, prescriptions, and hospital interventions.

“It’s necessary to work inside of an ACO model to lower the TCOC because this model brings alignment between primary care, specialists, and often hospital systems. The coordinated structure provides the platform for achieving this goal.” CHRIS WILSON, Senior Vice President of Business Development

Improving care efficiency, patient health outcomes, and self-insured employer savings are the key benefits of a health plan or insurance providing coverage within a value-based care (VBS) model.

QUESTION: WHAT DO ACOs DO?

ANSWER: ACOs provide a restructuring of the Fee for Service (FFS) model to a VBS model where providers are not incentivized by the volume of care (order, tests, surgeries, etc.) they provide, but instead the health outcomes of the population they are treating and the overall cost of treatment. ACOs accomplish this by:

  • Providing their network of healthcare professionals with software, information, and devices that allow them to communicate efficiently and improve the flow of patient data.

 

  • Ensuring network participants are meeting ACO standards for patient health improvement and experience.

 

  • Actively looking for ways to make treatments cheaper, more accessible, or efficient in delivery.

 

ACOs have the same goals with varying structures. Some are Independent Physician Associations (IPAs), independent hospital groups, the government via the Centers for Medicare and Medicaid Services (CMS), or allied provider organizations. (Those run by CMS share payment and performance standards nation-wide, varying only in implementation by state.)

ACOs are a sustainable solution to the healthcare industry’s currently unsustainable fragmented system. As ACOs become higher-performing and more common in commercial health plans, employers will find greater flexibility, total cost of care savings, and quality care for their employees within the networks they utilize.

Our Healthcare Highways Health Plan provides higher quality care at a lower cost, thanks to our carefully curated high-performance networks of value-based care-aligned service providers and our ability to transparently provide population health data in near real-time.

“Costs will continue to rise while quality stagnates as there is no incentive for change in the current fee-for-service [FFS] structure. Providers and hospitals are rewarded for doing more [in volume] today. The structure must change where those providers and hospitals are rewarded for doing the right things, delivering the right care at the right place and at the right time.” CHRIS WILSON SVP of Business Development.

Find out how to maximize your current plan here, and take back control and gain insight into your employee health benefits costs.