Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare and Medicaid Services to help facilitate this cooperation.
Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).
Write a 700- to 1,050-word executive summary that discusses the purpose of joining an ACO and the funding available through one. Include the following:
- Describe the organization you selected and the general services that would be offered to Medicare patients.
- Describe the types of ACOs recognized by the Centers for Medicare and Medicaid Services.
- Evaluate industry dynamics that would influence your organization’s decision to participate in an ACO.
- Identify the steps needed to participate in an ACO.
- Justify participation in an ACO for your organization.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Format your assignment according to APA guidelines.
Expert Solution Preview
The purpose of this assignment is to analyze the benefits and challenges of participating in an Accountable Care Organization (ACO) for a healthcare organization that accepts Medicare patients. In this assignment, we will discuss the organization selected and the general services it offers to Medicare patients. We will also evaluate the types of ACOs recognized by the Centers for Medicare and Medicaid Services, industry dynamics that influence participation in an ACO, steps needed to join an ACO, and justify participation in an ACO.
The healthcare organization selected for this assignment is an urgent care center. Urgent care centers are medical facilities that offer walk-in, extended-hour medical care for acute illnesses and injuries that are not severe enough to require emergency department care. These centers are staffed by licensed physicians, nurses, and other medical professionals who provide quality care to patients in a timely manner.
The Centers for Medicare and Medicaid Services (CMS) recognize two types of ACOs: Medicare Shared Savings Program (MSSP) and Next Generation ACO Model. MSSP is the most common type of ACO in which participating providers agree to work together to improve quality of care and reduce costs for Medicare patients. Next Generation ACO is a newer model that builds on the success of MSSP and offers greater flexibility and higher financial rewards for providers.
Industry dynamics that influence the decision to participate in an ACO include financial incentives, improved quality of care, and access to shared data. ACOs offer financial incentives to participating providers in the form of shared savings when they meet performance and quality targets. Also, by working together in an ACO, providers can improve the quality of care they offer by sharing best practices and utilizing resources more effectively. Finally, shared data can help providers identify areas where they can improve care quality and reduce costs.
To participate in an ACO, the healthcare organization needs to take the following steps: (1) Form a legal entity that is recognized by CMS as an ACO, (2) Establish an ACO participant list that includes eligible healthcare providers who agree to participate in the ACO, (3) Develop and implement policies and procedures that promote coordination of care and improve quality, (4) Participate in CMS quality reporting requirements to measure and report on quality of care, and (5) Enter into a contractual agreement with CMS to participate in an ACO.
Participation in an ACO can offer many benefits to the organization, such as financial incentives, improved care quality, and access to shared data. Urgent care centers can benefit from participating in an ACO as they can coordinate care with other providers and reduce costs for Medicare patients. By improving care quality and reducing costs, the organization can improve the overall efficiency of the healthcare delivery system and contribute to better health outcomes for patients.
1. CMS. Medicare ACOs – General Information. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html
2. Urgent Care Association of America. What is Urgent Care? Retrieved from https://www.ucaoa.org/About-Urgent-Care/What-is-Urgent-Care
3. CMS. Accountable Care Organization (ACO) 101. Retrieved from https://innovation.cms.gov/Files/x/aco-101.pdf