Accountable Care Organization (ACO)

An Independent Physician Association is owned and operated by a network of independent physician practices, while an Accountable Care Organization (ACO) can comprise doctors, hospitals, and other healthcare providers.

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers, who voluntarily come together to give coordinated, high-quality care to their Medicare patients. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time to avoid unnecessary duplication of services and prevent medical errors. What Are Accountable Care Organizations? – Words for Good. ACOs promote higher care quality at lower costs while shifting risk to providers, making the model a staple of value-based care. Therefore, when an ACO succeeds in delivering high-quality care and spending healthcare dollars more wisely, it will share in the savings it achieves for the Medicare program. Healthcare Provider/Provider & Provider/Payer Disputes | Kevin P. O’Mahony.

The ACO model was included in national healthcare reform legislation as one of several demonstration programs administered by the Centers for Medicare & Medicaid Services (CMS). Participating ACOs assume accountability for improving the quality and cost of care for a defined patient population of Medicare beneficiaries. ACOs, in turn, receive part of any savings generated from care coordination as long as the quality is maintained. Accountable Care Organizations | AHA.

Appropriateness of Care

A significant focus of ACOs is a concept referred to as appropriateness of care.

“Appropriateness of care aims to ensure that patients receive the right care, provided by the right providers, in the right place, at the right time, resulting in optimal quality care. It involves making informed decisions based on the best available evidence and the patient’s preferences and values. Appropriateness of care can improve health outcomes, reduce harm, and use resources efficiently.” Appropriateness of Care (saskhealthquality.ca)

HealthFocus can support appropriateness of care by collecting, consolidating, and analyzing data across a more distributed patient population into a single platform. This data aggregation makes it easier to identify gaps in care, opportunities to reduce the cost of care, and highlight population health measures. We also track quality measures specific to ACOs, such as patient engagement.

Risk Adjustment

“Risk adjustment is a process that takes into account the health status and spending of the enrollees in an insurance plan12. It is used to predict and compensate health plans for the costs associated with taking on members with chronic or high-risk conditions345.”

HealthFocus can capture diagnosis opportunities to align risk to reality by reviewing clinical and laboratory results that suggest possible diagnoses that haven’t been billed and historical diagnoses from primary, specialty, and other acute environments to ensure relevant conditions are re-diagnosed each year.

We provide consolidated insights within an actionable time frame using a format that is easy to understand. Providing a clear and complete picture of patient care helps reduce administrative burden and allows for more informed decision-making from the provider.