Assignment Week 6

Sonjae Mitchell

HCA 320

Aspen University
 Effect of accountable care organizations on the experience of patients and healthcare

providers

In accountable care organizations (ACOs), the healthcare providers and the physicians

work in collaboration in order to coordinate care through health information technology,

increased communication between patient and providers and care coordination staff

(Summers, de Lisle, Ness, Kennedy & Muhlstein, 2015). Better coordination between the

patient and the primary care doctor in an ACO ensure that right care is delivered to the

patients in the right time and right place. In ACOs, the payments are not linked to volume,

rather to quality and worth. Since the payments are outcome-focused, ACO is able to achieve

quality improvement goals and ensure high-quality care.

ACOs commit themselves towards patient and family engagement that endorse the

collaboration with patients through the stages of care design and delivery. This partnership could

be revealed in decision-making, management, and shared care planning. It can also be revealed

from the involvement of patient and families in the quality and practice improvement

interventions. ACOs are held responsible for both the patient experiences of care and health

outcomes (Summers, de Lisle, Ness, Kennedy & Muhlstein, 2015).

ACOs have the prospective to transform the way in which care is delivered and paid for so

that high quality, patient-centered, timely and coordinated care could be received by the patients.

Patients connected with ACOs obtain care from physicians and the hospitals that are given

rewards for keeping the patients healthy in right place and time through right care (Summers, de

Lisle, Ness, Kennedy & Muhlstein, 2015). ACOs are not being rewarded for the number of

diagnostic tests, procedures or services they provide but on the delivery of most reasonable and

highest-value care. Accountable care through care coordination ensure better health outcomes
and care experience for the consumers, enhance the use of health information technology and

ensure the developments of partnerships with patients and families that make them engage in

their care effectively.

Accountability Care Organization and the role of the healthcare worker in accountability

Because of the rising costs of healthcare and the aging population, it became important

for the government to take action to cut down the federal revenues and other federal programs.

Thus, the policymakers devised a system of shared responsibility and risk between the physicians

and the insurers. This is the central idea behind an ACO.

Accountable care organizations (ACOs) are where the physicians, hospitals and other

healthcare providers work in close collaboration to strive for high quality and care coordination

of health services across the patient populations. Thus, ACOs are the group of healthcare

providers that work in collaboration to ensure care coordination with a goal to deliver high-

quality patient-centered care and reduction in costs.

Nurses have a significant role in the delivery of quality care at lowered costs (Nursing

Alliance for Quality care, n. d). They can function as coordinators of care and can coordinate

care from a wide variety of settings like those of physicians, pharmacies and specialists. Nurses

can also converse and translate care interventions and therapeutic plans to the patients. Nurses

have expertise in health awareness and in the delivery of information across diagnosis,

medication and after the discharge. Nurses can also serve as data managers. They can perform

data analysis and explore innovative options in order to improve the safety and quality of care.
 Challenges for nurses in accountable care organizations

Policy barriers

The ACA gives the authorization of nurse practitioners as professionals in accountable care

organizations. However, this designation restricts the patients allocated to Medicare ACOs to

the ones who could be treated by primary care physicians. Thus, the patients connected to

these accountable care organizations would not be considered recipients if they opt for a

nurse practitioner as the provider for basic care. This barrier requires the resolution through a

change in the legislature.

Implementation barriers

As the ACOs strive to reduce costs, some of the organizations may reallocate the

assigned role of nurses to people with lesser clinical experience and education. Many nurses

raise a concern that these replacements may cause a devaluation of patient care (Nursing

Alliance for Quality care, n. d).

Need for IT

A successful ACO requires the need for information technology. IT would be required for

filling the many gaps in the industry that serve as an obstacle in the way of accountable care.

The major aspects of IT required for the successful functioning of ACO include

1. Electronic health records that could be easily accessed in various settings

2. Data analytic tools to assess the interventions of physicians and high-risk patients

3. Smart health records to be jointly preserved by physicians and the patients

Modifying patient behavior

 Changing patient behavior is critical to any of successful effort aimed at reducing

healthcare costs. Chronic conditions account for 69% of the healthcare costs (O'Halloran,

Depalma, Joseph, Cobelli & Sharan, 2012). These costs could be managed through

effective behavioral change among the chronically ill population and through

implementation of prevention efforts to avoid chronic conditions. However, it is no

simple task to change the behaviors of Americans at risk or suffering from chronic

illnesses.

The evolving role of healthcare workers in Accountable Care organizations

With a rise in the number of ACOs, they have become a major contributor towards the

accomplishment of HHS goal of directing half of Medicaid payments towards risk-based

contracts. They report remarkable changes to meet the goal of value-based payment model but

there exist significant differences between the models. Since it is required that the care models

should be tailored according to the needs of the local population, it is unlikely that a single model

of care emerges.

Transition to a team-based model is challenging. It requires considerable investment in

the human resources, adoption of novel technologies, variations in workflow and strategies to

help deal with change management. Each member of the healthcare workforce has to put effort

to improve organizational efficiency, community development, and financial performance. They

will have a role in accomplishing routine tasks, communicate with patient providers, understand

cultural differences of patients and ensure that patients may experience shorter waiting times.

Direct educational resources will be provided to lower-level professionals for ensuring

community development. They would be trained in billing and coding to accurately document

the receipt of services and procedures.

 References

Nursing Alliance for Quality care (n. d.). The Role of Nurses in Accountable Care

Organizations. Retrieved from http://www.naqc.org/Main/Resources/NursesRole-

AccountableCareOrg.pdf

O'Halloran, K., Depalma, A., Joseph, V., Cobelli, N., & Sharan, A. (2012). The role of

accountable care organizations in delivering value. Current reviews in musculoskeletal

medicine, 5(4), 283–289. doi:10.1007/s12178-012-9138-7

Summers, L., de Lisle, K., Ness, D. L., Kennedy, L. B. & Muhlstein, D. (2015). How

Accountable Care Impacts the Way Consumers Receive Care. Princeton, NJ: Robert

Wood Johnson Foundation.