By Stericycle Staff | Nov. 10, 2013
A key to proactive patient outreach is being open and willing to discuss confusing aspects of a patient’s healthcare with them. Some Medicare patients are perplexed by basic terminology, such as the term accountable care organization (ACO). They are concerned about how the ACO will affect their healthcare, its cost, level of care available and their relationship with their doctors. Explaining this new healthcare organization to your patients will let them understand that an ACO model is designed to be in their best interest – and that introducing accountability for care outcomes could be the best thing that ever happened to their care.
There are so many acronyms in healthcare that most patients at one time or another will transpose one for another. Some patients could easily mistake ACOs for HMOs. While ACOs and HMOs are both forms of managed care, your patients should understand at least the basic difference: that the HMOs were led by insurance companies and focused on costs where ACOs will be led by their healthcare providers and focused on health outcomes. Big difference.
What Is An ACO?
An ACO model encourages doctors, hospitals and other healthcare providers to join forces to care for a population of patients. ACOs agree to share responsibility for care delivery, costs, utilization of services and also to share risks. By joining these forces, the ACO is able to control costs by a) reducing the number of duplicate tests, duplicate prescriptions and duplicate consultations ordered and b) by working together across previously divided areas of care to ensure the patients get the most comprehensive care possible. The ACO intends to increase the patient’s access and improve the quality of care.
We need to make clear that ACOs, while a important part of “Obamacare”, are not exactly new. There are a variety of ACOs offered by the Center For Medicare and Medicaid Services (CMS) aka the federal government. According to Kaiser Health News last month, “About four million Medicare beneficiaries are now in an ACO, and, combined with the private sector, more than 428 hospitals have already signed up. An estimated 14 percent of the U.S. population is now being served by an ACO.”
Video: How Will The ACOs Affect Your Practice
Let’s step back a bit. Before discussing the ACO model with your patients, it’s important that you and your staff clearly understand it first. Reportedly, many physicians and healthcare providers are still confused about accountable care organizations and the implications of joining one.
Aditionally, on their website, the Center for Medicaid and Medicare Services (CMS) a helpful list of things that won’t and will change when a patient is cared for by and ACO.
CMS Shares What Will And Won’t Change
What will change for patients whose healthcare providers join an ACO:
Patients don’t have to fill out as many medical forms.
Fewer incidents of duplicating forms with the same information.
Connected healthcare network providers all share your information (if it’s okay with the patients).
Fewer duplicate tests because all tests are shared with network providers
What won’t change for patients whose healthcare providers join an ACO:
Cost of care when using Medicare should not increase.
Patients can choose any doctor or hospital who accepts Medicare.
Doctors do not have to be in an ACO for patient to see them.
Cooperation: The Newest Concept
A great example of unprecedented cooperation between competing healthcare organizations is the recent case of the five ACOs in Massachusetts, who are working together to improve care for all of their patients. In order to coordinate better care between each facility they are sharing information and working on process improvements to offer a more seamless level of care for patients who are being transferred between providers.
One classic example of a situation that will improve through heightened cooperation under ACO rules is a patient being transferred from a hospital into an extended care facility. The patient’s arrangements, nourishment schedule, medication and all other necessary comforts and treatments will be already coordinated before the patient is transferred to the new facility. Patients will no longer arrive to find a bed isn’t ready, there isn’t anything for them to eat and their medication isn’t on time, as is very common today under separated, cost-focused managed care. This logistical improvement alone is an amazing benefit to all who share in the care of the patients and obviously to the patient and their caregivers. This type of cooperation and obvious concern for the patients is designed to enhance and improve the provider-patient relationship – and along with it, improve health outcomes.