Jumping into the accountable care organisation model

Abstract

The US healthcare system is continuing to face many challenges, including rising healthcare costs, and issues related to quality and safety – driving healthcare reform. To address these challenges healthcare providers are looking to provide higher levels of care while controlling the cost of care. The approach that is rapidly being adopted is to establish Accountable Care Organizations (ACOs) or Clinically Integrated Networks (CINs). The number of ACOs across the US has grown significantly over the past several years. To effectively support an ACO or CIN model the organisation needs to address key focus areas that are different from traditional hospital or community practice group functions or capabilities. Establishing an ACO/CIN requires very different operations, financial, and technologies from traditional fee-for-service healthcare payment models. Many ACOs are challenged with becoming financially self-sufficient due to the significant upfront investments in provider performance programmes, technologies and infrastructure which may not be the best initial investments to drive the return of investment of a population health management programme. New ACOs/CINs and financially struggling ACOs/CINs can benefit by understanding the key areas to focus as they expand services. Knowledge gained from the paper provides ACO executives areas to focus to develop successful ACO operations.