MHA628 Week 3 Assignment
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University Of Arizona *
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628
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Health Science
Date
Nov 24, 2024
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docx
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MHA628 WEEK 3 ASSIGNMENT
1
Final Paper Prep
[WLO: 4] [CLOs: 2, 4, 5, 6]
Prior to beginning work on this assignment, review the following:
Patient-Centered Medical Homes: Were They Built to Last?
Links to an external site.
This assignment is designed to get you started on your research and development of the final paper. Go to Week 6, and review the requirements for your Managed Health Care Delivery Models final paper
. For the final paper, you are to choose a managed health care delivery model, an accountable care organization, or a patient-centered medical home. For this assignment, you will write a two-page detailed outline that addresses the first three requirements of your final paper.
For your Final Paper Prep, develop an outline that addresses the following:
Discuss the origin and structure of your selected managed health care delivery model.
Describe how your selected model strives to contain the costs or improve the quality of care.
Summarize health care providers’ contracts and payment methods in your selected model.
For assistance with your outline, review the UAGC Writing Center’s Outlining
Links to an external site.
page.
The Final Paper Prep
must be two to three double-spaced pages in length (not including title and references page and formatted according to APA Style
Links to an external site.
as outlined in the Writing Center’s APA Formatting for Microsoft Word
o
Links to an external site.
resource in the Writing Center for specifications.
Carefully review the Grading Rubric
MHA628 WEEK 3 ASSIGNMENT
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Links to an external site.
for the criteria that will be used to evaluate your assignment.
Links to an external site.
The Impact of Accountable Care: Origins and Future of Accountable Care Organizations
Links to an external site.
Barton Health Peek: Patient Centered Medical Home
Links to an external site.
What Is The BJC Accountable Care Organization?
Links to an external site.
resource.
must include a separate title page with the following in title case: o
title of paper in bold font
Space should appear between the title and the rest of the information on the title page.
o
student’s name
o
name of institution (The University of Arizona Global Campus)
o
course name and number
o
instructor’s name
o
due date
must use at least three scholarly sources published in the last 5 years in addition to the course text. o
The Scholarly, Peer-Reviewed, and Other Credible Sources
Links to an external site.
table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source.
To assist you in completing the research required for this assignment, view the Quick and
Easy Library Research
MHA628 WEEK 3 ASSIGNMENT
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o
Links to an external site.
tutorial, which introduces the University of Arizona Global Campus Library and the research process, and provides some library search tips.
must document any information used from sources in APA Style as outlined in the Writing Center’s APA: Citing Within Your Paper
Links to an external site.
guide.
must include a separate references page that is formatted according to APA Style as outlined in the Writing Center. o
See the APA: Formatting Your References List
MHA628 Week 3 Assignment
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Student’s Name
Institution Affiliations Instructor
Date
MHA628 WEEK 3 ASSIGNMENT
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Introduction Recent healthcare reforms in the US aim to improve treatment standards and control costs. The PPACA of 2010 has led to the development of innovative managed health care delivery models in response to this predicament. ACOs and PCMHs are receiving attention for their potential in healthcare delivery, emphasizing coordinated treatment and cost efficiency (Kaplan & Porter, 2011). This paper will focus on the Accountable Care Organization (ACO), a managed healthcare delivery model. The goal is to provide a thorough understanding of ACOs, including their background, structure, cost-cutting methods, quality-
improvement initiatives, contracting and payment practices among healthcare providers, and effects on major public health insurance programs like Medicare and Medicaid. Origin and Structure of the Selected Managed Health Care Delivery Model
The inception of Accountable Care Organizations (ACOs) may be traced back to the continuous healthcare reform initiatives in the United States. ACOs function as a managed healthcare delivery paradigm. Accountable Care Organizations (ACOs) were developed as a proposed resolution to tackle the urgent issues associated with the current healthcare system, specifically the fee-for-service framework (Tu et al., 2016). This model prioritized the quantity of services provided rather than emphasizing the quality and coordination of care. The roots of accountable care organizations (ACOs) can be attributed to the proposals put out by prominent entities such as the Medicare Payment Advisory Commission (MedPAC) and the Dartmouth Atlas of Health Care.
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The publications have brought attention to notable regional discrepancies in healthcare
consumption and expenditure, revealing inefficiencies and inequities within the system. The Patient Protection and Affordable Care Act of 2010 (PPACA) was largely responsible for the birth of Accountable Care Organizations (ACOs). Accountable Care Organizations (ACOs) have their roots in the Medicare Shared Savings Program (MSSP), which was implemented by Section 3022 of the Affordable Care Act (ACA). ACOs originated from the MSSP under the ACA. ACOs were incentivized to reduce healthcare spending without compromising quality under the MSSP (Pasquale, 2012). The legal framework aims to integrate ACOs with healthcare reform goals of coordinating treatment, improving patient outcomes, and managing
costs.
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ACOs promote cooperation and integration among healthcare providers. The ACO concept involves creating a large network of healthcare providers and organizations. The network includes hospitals, primary care physicians, specialists, inpatient rehabilitation centers, and outpatient rehabilitation centers. ACOs provide patients with a diverse network of
healthcare services (Rosenbaum & Burke, 2011). One essential element of accountable care organizations (ACOs) is establishing a clearly defined patient group for whom they bear responsibility. This population often includes Medicare enrollees, Medicaid participants, and persons covered by commercial insurance.
Accountable treatment Organizations (ACOs) emphasize the coordination of treatment, utilizing various strategies such as the implementation of electronic health records, the presence of care managers, and the establishment of care teams. These measures aim to address the issue of fragmented and uncoordinated care, which can lead to redundant testing, avoidable hospitalizations, and communication breakdowns among healthcare professionals.
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ACOs utilize a collection of quality indicators and performance measurements to gauge and ensure the efficiency of care provision (Rosenbaum & Burke, 2011). These metrics assess the level of treatment provided, the satisfaction of patients, and the overall results. The financial framework of Accountable Care Organizations (ACOs) is centered around value-based principles, offering monetary rewards to healthcare providers who successfully achieve predetermined cost and quality targets. Payment models commonly employed in healthcare settings encompass shared savings, risk, and capitation arrangements. ACO governance often includes members from various healthcare organizations collaborating to make policy decisions that support the ACO's mission. O'Halloran et al. (2012) found that ACOs have an advantage over traditional healthcare facilities due to their ability to adapt to local patient needs and healthcare systems. ACOs can effectively address local market challenges and possibilities due to their adaptability. The ACO model signifies a notable deviation from the conventional fee-for-service paradigm, as it prioritizes coordination, quality, and value. This highlights the continual evolution in healthcare delivery within the United States.
Cost Containment and Quality Improvement Strategies
The Accountable Care Organization (ACO) is a method of providing medical services that emphasizes both saving money and providing better care. Care coordination is one strategy ACOs use to reduce healthcare costs by eliminating unnecessary treatments and maximizing efficiency. Another crucial strategy is population health management, in which ACOs proactively engage on behalf of high-risk patients to avoid costly complications. ACOs
can better control costs by spotting patterns, allocating resources effectively, and making
MHA628 WEEK 3 ASSIGNMENT
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decisions based on accurate information gained via data analytics (Klein, 2010). Aligning financial incentives with the fulfillment of cost-saving targets, ACOs encourage healthcare providers to provide more efficient treatment by switching to alternative payment models, including shared savings and capitation.
Concurrently, ACOs place a premium on enhancing the quality of care provided by utilizing performance measures that evaluate patient outcomes, preventative services, and the patient's overall experience. These measurements serve as a standard by which care can be judged and improved upon. To standardize care, reduce variances, and improve quality, ACOs
advocate for evidence-based practices and clinical guidelines. Better health results are typically seen in patients actively involved in their care, emphasizing shared decision-making and patient participation (Klein, 2010). Within ACOs, performance reviews and outcomes assessments are carried out to improve care procedures throughout time, fostering a culture of continuous learning and improvement. Together, these methods help ACOs achieve their goal of providing affordable, high-quality healthcare to their members.
The ACO model promotes cost containment and quality improvement through strategic contracts and payment methods for healthcare providers. ACO contracts shift from fee-for-service to value-based payment models. Shared savings contracts involve providers agreeing to share in cost savings compared to a predetermined benchmark. If the ACO reduces costs and maintains or enhances quality, the savings are shared among the providers, creating a financial incentive for efficiency. Some ACOs have shared risk contracts where providers share financial losses if costs exceed the benchmark, increasing financial accountability. Capitation payment methods provide fixed per-patient payments to encourage
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efficient care delivery. Providers are responsible for managing care within the budget and absorbing excess costs. Another approach is a fee-for-service model with quality incentives, where providers receive bonuses for meeting quality and performance metrics in addition to traditional payments. Diverse payment methods and contract structures motivate healthcare providers in ACOs to manage costs and prioritize high-quality care, aligning with the ACO's goals of improving patient outcomes and containing healthcare costs.
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References
Kaplan, R. S., & Porter, M. E. (2011). The big idea: how to solve the cost crisis in health care [Internet]. Harvard Business Review Home
.
Klein, S. (2010). In focus: Building accountable care organizations that improve quality and lower costs—a view from the field. Online article
.
O’Halloran, K., Depalma, A., Joseph, V., Cobelli, N., & Sharan, A. (2012). The role of accountable care organizations in delivering value. Current reviews in musculoskeletal
medicine
, 5
, 283-289.
Pasquale, F. (2012). Accountable Care Organizations in the Affordable Care Act. Seton Hall L. Rev.
, 42
, 1371.
Rosenbaum, S., & Burke, T. (2011). Accountable care organizations. Public Health Reports
, 126
(6), 875-878.
Tu, T., Muhlestein, D., Kocot, S. L., & White, R. (2016). The impact of accountable care: origins and future of accountable care organizations. May 2015.