Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare & Medicaid Services to help facilitate this cooperation. Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).
Write a 1,050-1,200 -word executive summary that discusses the purpose of joining an ACO and the funding available through one. Ensure your summary does the following:
- Describe the organization you selected and the general services that would be offered to Medicare patients.
- Describe the types of Accountable Care Organizations recognized by the Centers for Medicare & Medicaid Services.
- Evaluate industry dynamics that would influence your organization’s decision to participate in an Accountable Care Organization.
- Identify the steps needed to participate in an ACO.
- Justify participation in an ACO for your organization.
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Executive Summary That Discusses the Purpose Of Joining An Accountable Care Organization And The Funding Available
Accountable Care Organizations (ACOs) are increasingly becoming a common feature in the healthcare landscape. They represent groups of healthcare providers who collaborate voluntarily to provide first-rate care to Medicare patients. ACOs have now become a welcome addition owing to their efficacy in enabling patients acquire much-needed healthcare services. Long-term care organizations would benefit greatly by partnering with ACOs, precisely because of a substantial population of Medicare patients in dire need of their services. This executive summary will explore the general services offered to patients from long-term care organizations, types of ACOs recognized by the Centers for Medicare & Medicaid Services and an evaluation of industry dynamics. Furthermore, the steps required to join an ACO will also be discussed in addition to a justification of participation by long-term care organizations.
Long-Term Care Facilities
Provision of long-term care is an essential part of healthcare organizations. Services offered by long-term care facilities mainly focus on personal and medical care to individuals who are incapable of managing autonomously. Assisted living facilities, skilled nursing facilities and care homes are some of the most prominent long-term care organizations. The population requiring care in these organizations are senior citizens with a variety of staid needs. Since most of the patients in long-term organizations are covered by Medicare, their daily care needs are usually provided by skilled nursing facilities (Cimasi, 2016).
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Nursing care is also provided to senior citizens in an organization’s care as part of the assisted living care program, which aims to improve their quality of life. It is critical to acknowledge that Medicare plays a significant role in the provision of care to patients by covering their Hospice use in long-term care facilities. Ambulance services are also provided to patients and may involve picking patients from their homes to receive the services required. Prescription drugs are also offered under this particular cover using pharmacies outsourced to supply medication. The collaboration between long-term care facilities and ACOs, therefore, allows Medicare to enable the provision of care to a vulnerable population.
Various Categories of Accountable Care Organizations
ACOs are currently an emerging aspect of healthcare which aims to improve the quality of services provided while ensuring that they are also cost-efficient. ACOs litter the healthcare landscape in the United States and are placed under several categories. These models include the Medicare Shared Savings Program, Advance Payment ACO and Pioneer ACO model (Zander, 2017). Under the Medicare Shared Savings Program (MSSP), healthcare providers are expected to liaise to provide superior care to recipients of Medicare Fee-For-Services (FFS). The Advance Payment ACO plan was designed for rural providers of care to coordinate their services within a specific locality. Under this dispensation, practitioners receive their monthly allowance upfront, which ultimately ensures that care infrastructure is coordinated appropriately. Similarly, the Pioneer ACO Model targets long-term care facilities with proficiency in organizing care for patients. It is a fast-moving approach which utilizes a payment model based on the specific needs of the target Medicare population. The aforementioned categories intend to coordinate care activities with private payers as a way of improving patient outcomes.
Industry Dynamics
Long-term care has recently emerged as one of the most noticeable hallmarks of the healthcare industry, currently experiencing steady growth. This development is widely attributed to a growing population of senior citizens who are a product of the Baby Boomer generation who now required long-term care. Entering the industry presents numerous benefits to those willing to embrace various dynamics present. The competitive environment created by the industry has introduced numerous improvements in the manner in which significant players provide long-term care. Many now go the extra mile when providing these services to ensure that clients receive the best quality of care while standing out among competitors. The provision of high-quality services is one of the primary strategies employed by practitioners in long-term care whose main objective is to remain ahead of the rest (Singh, 2014). Availability and easy access enable long-term care facilities to thrive in the provision of medical care using an engaging technique which often involves patients and their immediate family. By so doing, the highest level of care is provided, which benefits patients struggling with debilitating health conditions. Long-term organizations in the industry also apply cost-effective strategies which help them while remaining within the confines of state and federal regulations. Compliance to Medicare regulations also ensures that patients receive quality care when required.
Steps to Becoming an Accountable Care Organization
The process of becoming an ACO requires following a set of clear steps to ultimately assure patients of the highest quality of care within the industry. It begins with having a clear understanding of the model which a long-term care provider endeavors to implement. The primary purpose of this step is incentivizing the provision of care, which will ensure that patients receive high-quality services. This stratagem ensures a steady decline in care costs while still motivating providers to provide post-acute services. Becoming an ACO also requires dedication to the provision of care while investing time and money in the industry to create a fully-functional healthcare system. Furthermore, it also involves the recognition of information technology and its importance when providing the aforementioned services in a continuum of care. Robust systems represent transformative technology critical in the management of patient care which often aims to introduce aspects of efficacy in the management of specific patient populations (Harris, Karabatsos, Samitt, Shea, & Valentine, 2010, p. 89). The execution of clinical strategies also ensures that all care initiatives are aligned with guidelines. Medical practitioners should always be available for clinical decision support to improve patient outcomes. Patients are then stratified according to risk, which is regarded as an essential monitoring step towards becoming an ACO. Adherence to CMS quality metrics ensures that the efficacy of care is always assured which then improves performance.
Justification of Participation by Long-Term Care Organizations
ACO participation for long-term care organizations is a relatively simple process. Organizations are required to complete an application as an initial step towards cooperation. It is fundamental to collaborate with ACOs since they seek to improve healthcare and introduce benefits. Providers and patients now have a unique opportunity to interact directly while participating in the improvement of care. It also ensures patients receive high-quality care at the lowest available price. Additionally, ACOs provide long-term care organizations with an opportunity to offer continuum-wide services to their target market. ACOs guarantee that long-term organizations are continually improving while transitioning to a new competence tier.
Conclusion
Long-term care facilities endeavor to provide essential services related to assisted living facilities, skilled nursing facilities and care homes. A large number of patients relying on Medicare coverage is the chief reason why joining an ACO is now imperative for long-term care facilities. It results in a high quality of care which is also cost-effective and accessible to patients. Joining an ACO thus ensures long-term care facilities remain relevant in a rapidly transforming healthcare environment.
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