Accountable care organizations (ACOs) were formed to move the health care industry away from fee-for-service towards value-based care. ACOs strive to improve patient outcomes and population health management to keep costs to a minimum through care coordination and shared savings payment model.
Three-quarters of the total care a patient needs in a given year can be delivered in a primary care setting, hospitals, the organizations of physicians and other providers work towards providing timely and right care. This concept is central to the success of value-based care. Now providers across the care continuum engage in value-based care with the support of alternate care delivery and payment model.
Fee for service billing came in the way of providers looking more holistically at patient care.
Ed McGookin, MD, chief medical officer of Coastal Medical said that they recognized that patients need after hour services that offices weren’t equipped to provide that weren’t represented within Coastal. They accepted that patients would get those services from other providers, groups, or organization in the community that delivered high-quality medicine.
There was a level of trust among providers that everyone provided highest quality and lowest cost care possible until data showed otherwise. Health care system as a whole had to make some changes with how it paid for care and who patients are referred to.
Many of these high-cost services being outsourced from primary care could be taken care in-house with more robust staffing, improved technology, and later and longer hours. Prior to Medicare Shared Savings Program, many organizations lacked financial backing to implement such measures.
Inspite of all the efforts ACO still confronts issues while applying value-based care through the model.
There exists no universal definition of value for ACOs models thus, making it challenging for ACOs to continue generating success if the target is constantly moving.