Five Payment Models for ACOs: A Guide for Health Care Providers - Essay Sample

Introduction

Health care providers are connected directly or indirectly to Accountable Care Organizations (ACOs). These ACOs are organized bodies consisting of health care practitioners and hospitals that have come as one to give patients a variety of medical services as per contracts that they are responsible for ("5 Payment Models for ACO Providers: The American Academy of Actuaries broke down five popular ACO payment models in a recent report," n.d.). The ACOs are responsible for health care reimbursements and utilization management to improve efficiency and save costs. As Chief Accounting Officer, I would recommend shared savings and global payments for the ACO and ensure network care system to serve the patients and reduce waste in the care process systematically.

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Shared savings and global payments should be in place since they offer incentives to health care providers who reduce costs for patient populations. This is by giving the percentage of total annual savings realized from their effort. Global payments model ensures health care providers obtain payments monthly or annually despite the services they offered within the specific period. These incentivize health care providers to reduce spending. Hence, the provider choice of increasing their financial benefit via efficiency and reduced costs. The two payment models will help reduce the cost of care and improve efficiency.

Fee for service and bundled payments implementation for efficiency and systematic management of health care providers. In fee for services, the providers are incentivized to provide more treatment. This is because payments rely on the quantities rather than qualities of services offered. The bundled payments are full of risk if the cost of service of treatment exceed payment ("What is an ACO? Definitive Guide: Accountable Care Organizations," 2019). The providers hence get single payments for all services to the patient per single service of care. Therefore, the health care providers will work more on providing services to more patients to maximize financial benefits and reduce the cost to avoid gaining losses in case of exceeding payments.

Develop a health care provision system which can serve a patients' population as a utilization management strategy. This is by providing the appropriate health care resources such as health care practitioners and hospitals. The population can be assessed to establish the participants who will face bigger risks and therefore receive greater portions of savings. Also, clinically determining the total number of patients for which the organization is ready to take the risk ("What is an ACO? Definitive Guide: Accountable Care Organizations," 2019). This will help the ACO to strategically determine the risk to be faced and calculate the percentage of expected savings each participant is to get. Therefore, improving efficiency.

Improving the quality of the health care being offered to populations of patients systematically and ensuring the right quantity of health care is given. Through these payment models, the ACO will be able to make the quality of health care given by the health care providers better. This is through the shared savings model and global payments where the health care providers will focus on the quality of the services they provide. Also, getting rid of waste within the health care process systematically ("7 Steps to Navigate Payment Allocation under ACOs: Here are seven steps to follow when deciding how to share payments fairly while maintaining a profit in an accountable care organization," n.d.). Through the fee for service and bundled payments, the health care providers will focus on more patients, therefore, improving productivity. This will hence reduce the cost per member per month.

Recommending the payment models and utilization management strategies above will help the ACO achieve success and quality. The ACO should consider other sources of revenue not to be dependent on the health care providers. One way to decrease costs is to reduce healthcare use of expensive services, such as by decreasing hospital readmissions. This is because hospitals tend to have high costs for services offered. The ACO should also consider non-incentive methodologies to create accountability and cost reduction by the medical practitioners. The incentives can be added after attainment of results hence improving health care.

References

5 Payment Models for ACO Providers: The American Academy of Actuaries broke down five popular ACO payment models in a recent report. (n.d.). Retrieved from https://www.beckershospitalreview.com/hospital-physician-relationships/5-payment-models-for-aco-providers.html

7 Steps to Navigate Payment Allocation under ACOs: Here are seven steps to follow when deciding how to share payments fairly while maintaining a profit in an accountable care organization. (n.d.). Retrieved from https://www.beckershospitalreview.com/hospital-physician-relationships/7-steps-to-navigate-payment-allocation-under-acos.html

What is an ACO? Definitive Guide: Accountable Care Organizations. (2019, January 17). Retrieved from https://www.healthcatalyst.com/insights/what-is-an-ACO-definitive-guide-accountable-care-organizations