health care reform
Accountable Care Organizations and Changes in Healthcare

Over the last few years, the healthcare industry and its current practices have been a hot bed of debate and dilemma. Changes have been taking place since President Barack Obama took office and passed the Affordable Care Act in 2010. With the passage of this law, healthcare industries have been subject to more regulation that is supposed to ultimately, make sure everyone in the United States is affordably insured. One of the components that make up the Affordable Care Act reformation is the development of accountable care organizations, also known as ACOs. What is an ACO you might ask? Well, it is a group of doctors, hospitals and other health care providers that work together to make sure Medicare patients are given quality care at the right time. Currently, a Medicare patient, whose health insurance is paid for by the federal government, may have unnecessary or duplicate procedures because they go to a variety of doctors.  With each visit, the patient’s information doesn’t transfer so while they may have gotten blood drawn at the last doctor’s office, the new doctor also needs to perform this procedure for their personal records. Ultimately, that’s money coming out of tax payer’s income checks to pay for inefficient Medicare methods. What the ACO would like to aim for is to develop a network, much like HMO and PPO individual plans offer, for patients. The argument is that this would not only increase the quality of patient care but also increase efficiency and decrease spending. Insurers are having to figure out how to adjust their policies to make sure that patients are covered.

The Rise of the ACO

When the Affordable Care Act was introduced, it was received with a myriad of controversy and is still being hotly debated. But with the Supreme Court’s decision of its valid constitutional merit, changes have been on the course of implementation ever since. Enter the ACO. After the Supreme Court’s decision, the amount of approvals the federal government had to process multiplied significantly. It’s moved beyond solely providing for Medicare patients and is open to other people now and they are taking advantage of this new, affordable option.  A new report by consulting firm Oliver Wyman says that ACO’s now serve anywhere from 25-31 million people. Before they were assisting the 2.4 million on Medicare. The Oliver Wyman report writers said that , “We would argue that this is a remarkably quick growth for a new and complex form of payment and care delivery. We believe that though there is much work left to do, ACOs in a remarkably short period of time have become a substantial part of American healthcare, with the potential to catalyze lasting, positive change as they begin to deliver the results they promise.” This sounds like great news and the even better thing is that individuals who are covered with employee health benefits and those with individual health plans can participate in ACO’s as well. This wide range of coverage should help save on the nation’s hefty medical bill but many people want to know if their insurance will cover it.

ACO’s and Insurance

The main goals of ACOs is to nudge out the expensive fee-for-service health plans we have all become accustomed to over the years. While this system seems to make sense, it has cost the insured and their companies a lot of money because health care providers make money based on their services. The more procedures that are performed, the more money they make which can then be used to fuel research and make necessary upgrades. While the money may be used for positive purposes that ultimately benefit the patient and health care provider, it’s not an efficient method for promoting sustained health and there are those that take advantage of this. You get hurt, insurance companies get hurt. An ACO wants to solve this problem. They have already started working with some of the largest insurance companies in the United States to provide wellness based incentives for health care networks. Insurance companies develop a health plan contract for ACO networks, who are responsible for managing the plan for their patients. The network then uses the health plan to pay for the services their patients need. If the network as a whole  can work together to provide the most efficient and affordable healthcare to a patient, any money left over in the health care plan is then divided amongst providers for practice needs.

The ACO and You

If you are on a federally funded plan like Medicare or Medicaid, participating in an ACO could save you time and your health. Ultimately, it could help save the nation money by driving down federal costs for health insurance which could affect insurance premiums for many people. The movement is still fairly new but it doesn’t like it’s going anywhere anytime soon. If you want to know if you could participate in an ACO and still be covered under your individual or employer based plan, call your insurance company. They can let you know what ‘s available and direct you in the best direction.