Aco's Strategic Plan

Medicare Shared Savings Program provides and incentive to ACO participants that are capable of lowering growth in Medicare health care costs in addition to meeting performance standards for quality of care and putting patients first. It was not until October 20, 2011 the Center for Medicaid and Medicare Services (CMS) released the final details regarding the ACO that specified the Shared Savings program authorized by ACA. The purpose of the program should improve access to capital precisely targeting those smaller ACO entities which are physician owned and/or located in rural locations. CMS will not pursue recoupment of any advanced payments not repaid from shared earnings, if the ACO completes the full three-year contract term and decides

By accommodating to these changes the organization to better serve a greater population at a greater level of quality. Laws and policies also have impacted the organization, such as the Affordable Care Act (ACA). The ACA allowed more patients to have access of healthcare services, driving the demand for health care services higher. This called for the need to increase supplies and staff for the organization. With the ever-changing technology updates, the organization must keep up to date to provide the best quality of care available which can cost an organization extra time and

ACO’s rely heavily on healthcare providers for leadership where consequences rest solely on one individual. Their values are centered around the organizations goals which typically is concerned with its market value. The quality of care received from ACO’s are typically set in urban areas with large populations. This can lead to longer wait time’s and providers becoming less interpersonal with their patients. With increased patient volume and providers being overwhelmed, the quality of care can be dismal.

The Health Insurance Portability and Accountability Act (HIPAA) is a vital part of the health care industry’s day to day business. HIPAAs procedures define how healthcare companies receive and handle their clients’ health care information. HIPAA helps to protect the patient’s personal information through confidentiality and security procedures while being transferred, handled or shared with other healthcare providers (Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules, 2013). When a patient’s privacy is not regulated, third parties could buy and sell the information without the patients’ authorization. With HIPAA being in place, it prevents healthcare employees from divulging any patient information they

Healthcare organization becoming and maintaining the ability to be a highly reliable organization has developed into a critical focus for not only patient care but also regulatory agencies and managed care organization. In week 4, I chose for my health care organization, the staffing, and scheduling processes make the organization highly reliable through advanced-access scheduling which provides an efficient and patient-friendly method of scheduling to patients ' and the delivery of care. Through EHR we are able to provide patients with more fast, effective and efficient care with more easy access to their health record. EHR provide great benefits for the providers, patients, and health care organization. For providers, they are able to obtained

The paper on triple aim for Accountable Care Organizations (ACOs’) provides great insight into how we can contribute to solving the opioid crisis as curbing the opioid crisis will contribute to lowering cost, improving quality and improve population health overall. Given that by their nature and function seeks to coordinate and improve multiple teams and levels of healthcare providers and professionals insurers and patients which can be very complex. The paper used a very effective High Reliability Organization (aircraft industry) to analyze how; key processes through which organizations achieve reliability; leadership and organizational practices that enable it and the role that professionals can play when charged with enacting it. The

There are many things that define and promotes the use of accreditation as a means of accountability across the continuum of care. The market, regulation, and professionalism all affect the use of accreditation as a means of accountability across the continuum of care. The role of the market play in defining and promoting the use of accreditation as means of accountability across the continuum of care is that money talks. Health care purchasers and consumers can use money as a mean to stimulate organizations to improve quality by either rewarding or punishing the organization base on performance or progress. (1) Healthcare consumers and purchasers are demanding more information regarding quality of care.

Medicare reimbursement services can also provide incentives for healthcare providers to focus on preventative care and chronic disease management. For example, Medicare offers financial incentives for providers who participate in programs that focus on reducing hospital readmissions and improving care coordination for patients with chronic

The Affordable Care Act has major impact on the health care system, some positive as well as negative. Although it provides the Americans people with better health security by expand coverage, hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans, it also cause major issues for providers and small practices. The Patient Protection and Affordable Care Act will bring several changes in within the health care system (Morrison & Furlong 2014). Some of the areas that will be affected by Patient Protection and Affordable Care Act (PPACA) include the way cares are being provided and cost of care. In addition, Patient Protection and Affordable Care Act will focus on designing

These include the creation of accountable care organizations and the implementation of preventative care services, which can reduce the need for expensive emergency care (Rice et al., 2014). Despite these challenges, I believe that the ACA has been a positive step forward in expanding access to healthcare and improving the quality of care for millions of Americans. As a healthcare professional, I support the continued implementation and improvement of the ACA in order to ensure that all Americans have access to affordable, high-quality

Many times, patients ask for test and procedures that are not necessary. In the third payer programs, the gatekeepers are lacking to control unnecessary or duplicate treatment. The nurse can help prevent abuses and inefficiencies with keen awareness of the patient and the care needed. Quality care does not mean that every test imaginable is perform, it mean the best care available to treat a specific need of the patient.

A HMO is a plan that provides comprehensive health care services, with an emphasis on preventive care, for a fixed (capitated) payment. HMOs are the most stringent form of managed care. Participants must select a primary care physician, who acts as a “gatekeeper” for most services covered by the plan. If the patient does not channel care through the gatekeeper and obtain care at one of the HMO’s participating facilities, it is generally not covered under the plan. There are two basic types of HMOs — the group or staff model and the independent practice association (IPA).

The Leapfrog Group (“Leapfrog”) is a hospital reporting organization created to provide purchasers with transparent health care quality information. Prior to Leapfrog’s creation, employers who purchase health care found it difficult to provide high-quality care to their employees because they could not identify which providers were best. A group of employers developed Leapfrog in response to this lack of transparency and accountability. Sixty purchaser members were included in the launch of Leapfrog in 2001, with funding from Business Roundtable, the Robert Wood Johnson Foundation, and the Commonwealth Fund.1 The mission of Leapfrog is to “trigger giant leaps forward in the safety, quality and affordability of U.S. health care by using transparency

A patient is going to have a different idea of how a health care should be managed. This in contrast to the way a physician may think the administration should be managed. Furthermore, each different stakeholder involved would have their own ideal reasons to why the health care administration

To further expand the P4P programs, the 111th Congress enacted the Patient Protection and Affordable Care Act of 2010 (PPACA 2010), which came to be known popularly as ‘Obamacare’ (Nix, 2013) and shortened as Affordable Care Act (ACA), and mandated CMS to design a hospital value-based purchasing (HVBP) program that will link Medicare payments to health care provider quality outcomes (Baird, 2016). It also encouraged Medicare experimentation in ascertaining each P4P program’s