The United States spends much more on healthcare than any other country, without necessarily improving the quality of care or patient outcomes. Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs.
For a living, I consult with physicians daily and most of them are apart of an ACO. One of the main benefits providers experience when joining an ACO is an improved workflow. When operating independently, doctors may have to consider various financial factors when determining treatment plans for patients based on insurance benefits. By joining an ACO, providers can participate in a more population-based approach to healthcare. There is no worry over falling in line with insurance providers because patients will always receive right care for their conditions. Under Medicare ACO plans, patients are assigned to doctors based on which primary care physician provides the most care to the patient. Although not all ACOs are for Medicare patients, this article focuses on Medicare ACOs, because of the emphasis Medicare places on ACOs as a tool to control cost and improve quality. Unlike HMOs, ACOs are designed to increase quality of care without limiting patients’ choices. With the possible exception of a hospital ACO, Medicare beneficiaries can obtain care from any provider that accepts Medicare. Therefore, Medicare patients have few incentives to use the most effective provider. To be successful, ACOs need to change patients’ behavior through incentives.
Another improvement for providers is the freedom to share best practices and treatment strategies with other members of their ACO. Being involved in a network allows physicians to better collaborate on the various modalities they use on their patients. This can help providers who feel stuck or lost on a particular condition or injury.
However, a major issue is whether the United States is getting its money’s worth. The costs of many healthcare procedures are much greater than the benefits, and some procedures provide little or no benefit to patients. The US healthcare system is broken financially and quality-wise. The present financing system is not sustainable; nearly 20% of the US gross domestic product is spent on healthcare.1 The United States spends by far more on healthcare than any other country, but its outcomes are not better, and universal access is lacking.
ACOs are designed to give incentives to physicians and hospitals to decrease costs by sharing in the cost-savings; however, providers risk being penalized if they do not decrease costs or do not meet certain quality standards. ACOs are still in their early stages of development.