ACO's - Not Just Changing Healthcare Delivery
Posted by John Carradine on Mon, Apr 04, 2011 @ 09:59 AM
Accountable Care Organizations (ACO) are getting more and more attention, especially as we progress closer to 2012 when most of the provisions for ACOs go into effect. An ACO is an association that consists of a group of doctors and hospitals that have decided to come together with the intended purpose that through collaboration, transparency, and cooperation, they can provide the best care for their patients. In ACOs, doctors are accountable for improving the health of their patients. It’s a team effort, not an individual effort. In these practices, doctors are rewarded for meeting targets that improve outcomes and lower costs. Their benchmarks are based on regional standards of care, so that local factors impacting health can be taken into account. The idea originated out of the need to create a system that would help to ensure that all patients receive the best health care possible. In order to realize this necessary change, there had to be a shared responsibility by all involved parties.
New Healthcare Law
Accountable Care Organizations are included in the Patient Protection and Affordable Care Act and even though the new rules take up only a few pages, they are one of the most highly discussed facets of the new health care bill and accordingly are a hot topic for debate. Along with bringing a new approach to delivering medical care, there will be new payment models under Medicare and most likely private insurance as well. What seems lost in the discussion is that ACOs cannot be particularly small, and managing populations of members and dealing with the administrative requirements of doing so requires sophisticated systems, not just for healthcare delivery, but for administration.
Affect on TPAs and Insurance Payers
Third Party Administrators and Insurance Payers will have a role in the administration and delivery objectives of ACOs. Right now, ACOs are focused on organizing, contracting and determining how these new provider groups will work. But someone has to handle the administration and payment processes for these groups, and that’s where we see forward looking administrative organizations going. Payers will see an increased need for transparency as institutions and systems begin to merge and may find that some administrative duties will soon either be shared or reduced. In addition, new payment and reimbursement models will need new administrative systems capabilities.
Healthaxis’ Role
Healthaxis is looking at the specific needs of ACOs and their administrative partners to understand how we adopt our systems and solutions to meet this new model. We know that our history of core benefits administration is a key building block, and we are making use of the flexible nature of our systems technology to build new and more advanced capabilities that will be able to meet the needs of a changing landscape. We’ve been meeting with industry leaders to understand the Payer’s role in administration, and we expect to be one of the leaders in systems development for this potentially large segment of the healthcare market.