Question

Discuss examples of ACOs that have succeeded as well as failed in the Medicare, Medicaid, and commercial markets.

a. Discuss the factors that contributed to an ACO's success.

b. Discuss the factors that contributed to an ACO's failure.

c. How might the challenges faced by one of the ACOs have been mitigated?

Answer 1

There are various opportunities to increase the performance of VBP programs, which include improving the quality measurement science, strengthening the size and design of incentives, reducing health disparities, establishing outcome measurement, choosing appropriate comparison targets, and determining the role of VBP to alternative payment models. These programs play an important role in healthcare delivery, and they serve as an opportunity for providers to build the infrastructure needed for value oriented care.

There are numerous programs based on the performance on pays, encompassing a wide variety of healthcare delivery settings, which are implemented by commercial insurance companies and by the centers for Medicare and Medicaid Services. This gives a detail historical and current VBP programs and specific evaluation studies, ranging from the outpatient to the inpatient settings.

Medicaid spending has grown very high which puts similar pressure on states. In the private sector, employee health care costs, has increased which puts the weight on company’s balance sheets, affecting business operations and employee wages.

Policy options provided by the companies for slowing health care spending are varied. Some focus on changing the provider’s incentives, while others focus on changing the patient’s incentives. Here some of the policy options are based on federal solutions, while others are based on market solutions. However, in the current policy, payment reform for physicians and hospitals has emerged as a leading aspect for health care spending. This is resulting for physicians and hospitals to form an integrated provider organizations to take on these new payment systems. The pace of this change has been rising.

Hence, the best contribution of the ACO model is that it gives providers a reason to change the culture of medicine. It gives opportunity to providers to work together and coordinate care in a way that was not rewarded under fee for service. This provides a single, collective contract at the organizational level, and the providers are comfortable and are in it together.

The ACO’s have diverse contracting arrangements and have displayed wide variations in their performance. Here, ACO delivery systems remain at a nascent stage. Due to this the structural differences between commercial and noncommercial ACOs have important factors to consider as public policy efforts continue to evolve.

However, because of this, much attention has been focused on ACO performance, there is less information on how ACOs are internally structured to support delivery system reform and achieve performance benchmarks. Due to the large variation in the outcomes, it is important that the organizations’ internal processes needs to be well understood.

As a consequence, these ACOs need to be structured differently that participate only in public programs, such as Medicare, and their constituent provider organizations may be more highly consolidated. The extent of any structural changes may translate into lower costs and improved health care quality remains unknown.