Cost Accountability For Health Services In The United States

Author : Michealle Gady
Publisher :
ISBN 13 :
Total Pages : 11 pages
Book Rating : 4.:/5 (773 download)

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Download or read book Putting the Accountability in Accountable Care Organizations written by Michealle Gady and published by . This book was released on 2012 with total page 11 pages. Available in PDF, EPUB and Kindle. Book excerpt: Every year, health care in the United States becomes more expensive. Yet despite the growth in health care costs, quality has not kept pace. As a result, people in the United States pay more for their health care but receive lower-quality care than people in other developed countries such as Germany and Japan. One of the reasons for this is the way we pay for health care. Most insurers pay providers for each health care service they deliver, regardless of the quality. The more care that is delivered, the more the provider is paid. Providers are not usually paid to work together and coordinate a patient's care, nor are they paid to help patients be active participants in their health care (for example, by jointly developing a care plan). This poorly structured payment system has created a highly fragmented health care system that is very inefficient, with duplication of tests, preventable hospitalizations, and poor care for chronic conditions. This inefficiency causes costs to rise even further and leads to more poor-quality care. To begin to address this problem, the Affordable Care Act included many new initiatives that are designed to change the way health care services are delivered and paid for in Medicare and Medicaid. One of the new models is the Accountable Care Organization (ACO). An ACO is an entity made up of health care providers that agrees to be held accountable not just for lowering the cost of health care, but also for improving health care quality across the continuum of care, including acute care, post-acute care, long-term care, and behavioral and mental health care. Advocates have an important role to play in helping develop ACOs that are focused on the beneficiary and that are accountable to the community in which they are located. The goal is to improve the care that beneficiaries receive, not simply to create a new way to pay providers. Advocates can work with payers, such as Medicaid and private insurers, or with providers, such as a local hospital, to ensure that there is an appropriate balance between the financial incentives and the accountability measurements that providers must meet. This means ensuring that there is a meaningful link between financial incentives and quality improvement, as well as ensuring that there are adequate and appropriate quality measurements that evolve over time. When working to strike this balance, advocates will face several key challenges. This brief examines some of the challenges that advocates will face when working with policy makers, insurers, and providers to develop accountability mechanisms for ACOs that ensure that beneficiaries receive high-quality care at a lower cost.