by New Models of Care Delivery Provide Better Outcomes at Lower Cost
With rising healthcare costs straining budgets across the country, new models of care delivery are gaining traction as a way to improve outcomes while reducing spending. Accountable care organizations (ACOs) aim to do just that by making groups of doctors, hospitals, and other healthcare providers collectively responsible for the overall quality and costs of care received by their patients.
Coordinating Care Through Shared Accountability
A key focus of Accountable Care Solutions is improving care coordination and managing patient health across various providers and care settings. By establishing networks of doctors, hospitals, and others who work together to coordinate treatment for patients, ACOs hope to reduce avoidable hospitalizations, duplication of tests and procedures, medical errors, and other inefficiencies that plague the current fragmented system. This coordinated, team-based approach is designed to ensure patients’ various needs are addressed and care transitions between providers are seamless.
To incentivize better collaboration and performance, ACOs receive payments based in part on meeting quality benchmarks and slowing cost growth. If an ACO’s overall treatment costs are lower than projected and quality targets are achieved, it keeps a portion of the savings. This accountability for combined quality and spending establishes shared motivation among providers to help patients stay healthy at an affordable cost. Some ACOs even employ nurses to conduct home visits and coordinate care for patients with complex or chronic conditions.
Improving Access to Preventive and Primary Care
Many ACO models focus on improving access to preventive care, management of chronic diseases, and other forms of primary care known to have substantial impacts on long-term healthcare costs and outcomes. Easy access to doctors, screenings, health education, and disease management programs encourage better lifestyle habits and medication adherence that can ward off more serious health issues down the road. Telehealth services have grown amid the COVID-19 pandemic, as well, expanding options for remote monitoring, physician visits, and other tools that make ongoing care more convenient without needing an office visit.
By basing part of their own revenues on keeping patients healthy rather than strictly fee-for-service billings, providers in accountable care solution organizations have a direct incentive to place increased emphasis on preventive healthcare practices proven to reduce utilization of costlier services such as emergency room visits and hospitalizations. This shifts the focus from reactive sick care to proactive wellness and chronic condition management.
Win-Win for Providers and Patients
Preliminary studies indicate that well-designed accountable care solution organizations programs can achieve savings of around 5-10 percent from healthcare costs while maintaining or improving quality outcomes. For example, one study found patients in high-performing ACOs suffered 11% fewer inpatient admissions and had 8% lower total healthcare costs compared to similar patients not in ACO programs.
Benefits extend to both patients and providers in these models. Patients benefit from better care coordination to manage their overall health while providers benefit by keeping more of their patients healthy through a higher-value approach to care. As the healthcare industry continues adapting to control ever-rising costs, accountability-based models like this show promise if properly tailored to local communities. With refinements over time, they could become a mainstay for enhanced outcomes and affordability through team-based and preventive care.
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1. Source: Coherent Market Insights, Public sources, Desk research.
2. We have leveraged AI tools to mine information and compile it.
