Discuss the role of the Accountable Care Organization and how this differs/relate from the Patient Centered Medical Home
ASSIGNMENT INSTRUCTIONS
*DNP Class: Collaboration in Healthcare Delivery
*ASSIGNMENT:
in January of 2015 President Obama established the Health Care Planning and Learning Action Network (HCPLAN). This entity has developed and produced multiple White Papers to assist the US health care system in transforming to population based health. Please review the Alternative Payment Model White Paper, and discuss the role of the Accountable Care Organization and how this differs from the Patient Centered Medical Home. (The Alternative Payment White Paper may be found at www.multiplechronicconditions.org under Guidelines, then Affordable Care Act.) ---YOU CAN CHECK IT, BUT IT’S LONG AND TEDIOUS! Take a look: I uploaded the PPT “2016 HCPLAN Alternative Payment Models (APM) White Paper”
2016 HCPLAN Alternative Payment Models (APM) White Paper. (2016, January 12). Retrieved May 27, 2019, from http://www.multiplechronicconditions.org/
* I FOUND ARTICLES that can help us to develop the paper with the information that we need. See below…
FOCUS ON THIS ONLY****SO THE ASSIGNMENT CONSIST ON: Discuss the role of the Accountable Care Organization and how this differs from the Patient Centered Medical Home.
***Also, they don’t differ… Both have similar aims and purposes
“Accountable care organizations and patient centered medical homes both aim to improve the delivery of care to the patient”. Please see the example of other student assignment on this topic (Uploaded). Can’t copy but guide you & give you an idea on how to do the paper.
* I’m a nurse practitioner (Advanced practice nurse). This assignment is for a DNP (Doctor of nursing practice) class and the grading is rigorous including grammar and APA style.
*Please don’t start with sentences that start with “this, these, it…etc” this is vague and not use in formal writing. Need to specify what we are talking about. Also don’t use citations in the middle of the sentence. Avoid “as well as” as much as possible.
Thank you! SEE BELOW…..
Patient centered Medical Home and The Accountable care organization
Patient Centered Medical home
*MUST REFERENCE THE TEXTBOOK (see uploaded copies #3) about this topic
Freshman, B., Rubino, L., & Chassiakos, Y. R. (2010). Collaboration across the disciplines in health care. Sudbury, MA: Jones & Bartlett Publishers.
Patient-Centered Care
The concept of the Medical Home has evolved directly from the patient-centered care movement.
This model for care was devised to sustain the patient-provider relationship to encompass comprehensive, safe, and quality care.
- ****Kazak, A. E., Nash, J. M., Hiroto, K., & Kaslow, N. J. (2017). Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges.American Psychologist, 72(1), 1-12. DOI:10.1037/a0040382
The patient-centered medical home (PCMH) is an increasingly common model of health care delivery with many exciting opportunities for psychologists. The PCMH reflects a philosophy and model of care that is highly consistent with psychological science and practice. It strives to provide patient-centered, comprehensive, team-based, coordinated, accessible, and quality and safety-oriented health care delivery to individuals and families. Patient-centered underscores the partnerships essential to the PCMH and a focus on respect for patients’ personal, family, and cultural backgrounds, and attention to care that has value to patients and families. The Triple Aim (improving patient experiences, promoting the health of populations, and reducing the per capita cost of care) exemplifies the paradigm shift that undergirds changes in health care and guides objectives in the PCMH.
2.****Howard, H. A., Malouin, R., & Callow-Rucker, M. (2016). Care managers and knowledge shift in primary care patient-centered medical home transformation.Human Organization, 75(1), 10-20. DOI:10.17730/0018-7259-75.1.10
One of the most significant transformations occurring in health care in the United States is the implementation of the patient-centered medical home (PCMH) model in primary care. Becoming a PCMH practice involves change on a number of levels from business performance reorganization to individual patient empowerment. The overall goals are improving care quality, cost effectiveness, and population health outcomes. A central objective of the PCMH model is to address the rising costs stemming from the escalation of chronic diseases. Primary care thus shoulders the double burden of preventing and managing rising chronic disease while also being responsible for lowering health care costs. Successful PCMH implementation projects demonstrate that they "offset the new investments in primary care in a cost-neutral manner and...produce a reduction in total costs per patient" (Grumbach et al. 2009:1 ). Cost reductions for employers and health insurers, measured through lower hospitalizations and emergency department visits, are significant drivers behind their investment in PCMH transformation projects. Yet, the prevention and management of chronic diseases such as diabetes are increasingly multifaceted. They involve many intersecting physical and social complexities and an exponential multiplication of technologies available to address them. In this context of increasing complexity, PCMH redistributes patient interaction from physicians to a range of other health care providers, and practice transformation involves the "empowerment" of patients as well as of non-physician clinical and other staff. A team approach to patient care seeks to release physicians from the overload of chronic illness management and administrative functions by devolving the time-consuming aspects of patient care, such as education and support (e.g., dietary and self-monitoring tasks of diabetes management), to other clinical staff. This is meant to encourage comprehensive patient care and pay off in business efficiencies and quality improvements. The PCMH moment highlights the underlying social forces which impact health outcomes as health care providers are called upon to delve extensively into the personal lives of patients and engage with community resources to promote health education, lifestyle, and environmental changes.
This includes the notion of "partnership," for example, which is a central organizing concept in becoming patient centered. It is used to frame contact between the practice and patients, the teamwork of practice staff, and relationships with others in the medical neighborhood.
A medical home is an approach to providing comprehensive primary care that facilitates partnerships between patients, clinicians, medical staff, and families. A medical home extends beyond the four walls of a clinical practice. It includes specialty care, educational services, family support and more.
Patient centered medical home
3.****Tuepker, Anaïs,PhD., M.P.H., Kansagara, Devan,M.D., M.C.R., Skaperdas, E., B.A., Nicolaidis, Christina,M.D., M.P.H., Joos, S., PhD., Alperin, Michael,M.D., M.B.A., & Hickam, David,M.D., M.P.H. (2014). "We've not gotten even close to what we want to do": A qualitative study of early patient-centered medical home implementation. Journal of General Internal Medicine, 29, 614-22. DOI:10.1007/s11606-013-2690-z
The patient-centered medical home (PCMH) has gained considerable traction as a proposed solution to persistent challenges facing US healthcare in general and primary care in particular.1–3 Defined by a focus on care that is team-based, data-informed, highly accessible, continuous, and coordinated across the spectrum of care, the PCMH is associated with positive outcomes for patients. Medical home features, such as enhanced patient access, improved scheduling, care provider continuity, and care coordination activities, have been associated with lower rates of avoidable hospitalizations and decreased Emergency Department use.
Accountable Care Organizations
Accountable Care Organizations (ACOs) are groups of health care providers that work as a team to coordinate care for a group of patients, with the goals of providing high-quality, patient-centered care and reducing costs.
1.****American Academy of Family Physicians. (2019). Accountable care organizations. Retrieved from: https://www.aafp.org/practice-management/payment/acos.html
An accountable care organization (ACO) is a group of health care providers who agree to share responsibility for the quality, cost, and coordination of care with aligned incentives for a defined population of patients. With the shift to value-based payment, it is increasingly important to understand the components of an ACO. Primary care is the foundation of a successful ACO that uses transparent performance measures to achieve the Quadruple Aim of improving population health, improving patients’ experience of care, reducing the total cost of care, and improving the work life of health care providers. In an ACO, strong primary care physician leadership of the care team is necessary to improve care coordination, enhance preventive care delivery, and reduce or eliminate duplicative or unnecessary services.
An ACO is a group of health care providers who agree to share responsibility for the quality, cost, and coordination of care with aligned incentives for a defined population of patients.
Family physicians should work toward implementing and improving advanced primary care functions, including:
- Increased access, Continuity of care, Coordination of care across the medical neighborhood, Risk-stratified care management, Patient and caregiver engagement, Planned care for chronic conditions and preventive care. (AAFP, 2019)
2.***Panning, R. (2014). Accountable care organizations: An integrated model of patient care objectives. Clinical Laboratory Science, 27(2), 112-118.
Accountable care organizations (ACOs) ----to achieve higher quality care, decreased costs, and improved population health.
The Accountable Care Organization is a group of providers who are "accountable for the quality, cost and overall care" of patients. ACOs are essentially partnerships between health insurers/payers, hospitals, primary care physicians and post-acute care providers (long-term care and home care) to manage all health care for its members. This concept, not limited to federal healthcare reform envisions multiple providers assuming joint accountability for improving the quality of care and slowing the growth of health care costs. The success of the ACO model relies on its success in incentivizing hospitals, physicians and post-acute care providers to form partnerships that facilitate coordination of care delivery across the settings of care. It is the transitions in health care that most contribute to the excessive cost and waste in the system.
ACOs are a group of providers that work together to coordinate care and share in the costs saved by reducing the cost of care. ACOs are intended to be patient-centered, involving coordination, transitions and patient involvement. It is intended that ACOs demonstrate innovation in achieving better value for the system and the patient. To support this, data must demonstrate improved healthcare delivery and outcomes. In order to achieve savings and earn incentives, the ACO must meet quality standards in five areas - patient caregiver experience, care coordination, patient safety, preventative health and elderly health/at risk populations. From a reimbursement perspective, for chronic disease the ACO will transition from fee-for service to a model of population management and reimbursement in the form of a bundled payment. This is a significant paradigm shift for the healthcare industry.
The ACO model, as a component of national healthcare reform, was proposed as a demonstration project to be administered by the Centers for Medicare and Medicaid Services (CMS). Along with a bundled payment model and other initiatives that address care delivery, the ACO organizations agree to assume accountability for improving quality of care and the overall cost of care for a defined and assigned patient population of Medicare beneficiaries. The ACO will receive any savings achieved, as long as the prescribed quality benchmarks are achieved. The goal is to improve patient outcomes and quality and reduce overall cost.
For an ACO to be successful it needs to focus on the following core competencies during its initial three-year commitment.2,4 The ACO must have a defined leadership with a formal legal structure, employ enough primary care providers to treat the defined beneficiary population as defined by CMS, implement a mechanism to promote evidence-based medicine, report on quality and cost measures and coordinate care, possess an organizational culture of teamwork, develop a structure and relationship with other partners, maintain an information technology infrastructure for population management and care coordination, implement an infrastructure for monitoring, managing and reporting quality, manage financial risk, receive and distribute payments and savings, possess resources for patient education and support, spread and disseminate best practices, establish linkages and reach out to public health and community resources, and participate in regional health information exchanges to share health information in order to improve the health of the community.5
3.***Mishra, M. K., Saunders, C. H., Rodriguez, H. P., Shortell, S. M., Fisher, E., & Elwyn, G. (2018). How do healthcare professionals working in accountable care organizations understand patient activation and engagement? qualitative interviews across two time points. BMJ Open, 8(10), 1-9. DOI:10.1136/bmjopen-2018-023068
“Meaningful patient activation and engagement (PAE) is essential for achieving high-quality, patient-centered care.1–4 There is wide acceptance that activated and engaged patients and families are more likely to manage their health effectively and have improved health outcomes at reduced costs.
the accountable care organizations (ACO), is considered leader in patient engagement”.
4.***
Accountable Care Organizations (ACOs)
What is an ACO?
ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in delivering hig
h-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.
Centers for Medicare & Medicaid Services. (2019). Accountable care organizations. Retrieved from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
**** YOU CAN USE ANOTHER ARTICLE IF YOU NEED TO, BUT Remember reference must be scholarly, peer reviewed article. References MUST be scholarly journal articles (Nothing from conferences, goggle, .com). References must be within 5 years, except textbook.
