CRA500 Module 4 - Case

Accountable Care Organization, Reimbursement Systems, and Affordable Care Act Name Course: CRA500 MODULE 4 - CASE Instructor Date Background The Accountable Care Organizations emerged after health care reform legislations under President Obama, where the organizations are held accountable for their expenditures and care. The model of ACOs integrates the healthcare providers in a network to improve access to quality and affordable health care. The Affordable Care Act (ACA) is the latest federal legal framework outlining provisions to guarantee access to care and increasing insurance coverage to the uninsured (Rosenbaum, 2011). The ACA emphasizes shared responsibilities, among health care providers, employers, individuals to improve the access, affordability, and quality of care. The ACO, private physician practices, hospitals, and health insurance organizations The ACO has affected the private physician practice as hospitals need to identify a primary-care provider that belongs to the ACO. Even before the adoption of ACOs, there was a shift towards hospital-based medicine, and since private and independent practitioners have tended to avoid working with larger healthcare organizations they may miss out on the benefits of Affordable Care. Private practitioners need to take into account the health reforms when providing care and this has increased regulatory burdens and legal compliance responsibilities. Private physician practitioners have at times witnessed increased number of patients coming for checkups as the ACOs emphasize the preventive and coordinated care approach to improve patient outcomes. Independent practitioners with more resources are better placed to be integrated into ACOs for them to ensure sustainablity (Colla, Lewis, Shortell, & Fisher, 2014) The ACO has encouraged the integration of hospitals where there is increased networking among hospitals and this may accelerate mergers. For the large hospital systems, the ACOs provides an opportunity to attract more physicians, and the smaller hospitals are facing challenges as the inpatient volume decreases. Hospitals increasingly focus on preventive care and quality improvement, since they are quality indicators to evaluate patient outcomes. For hospitals that do not meet the expected outcomes, there are risks of penalties for failure to improve the quality of care despite networking with partners (Rosenbaum, 2011). The objective of reducing hospital readmission has influenced decision makers to look into ways to improve the quality of services and patient outcomes. For the health insurance organizations, the adoption of ACA is beneficial to the extent that hospitals focus on improving the quality of care without incurring heavy costs. Both hospitals and physicians receive financial incentives to improve the quality of care without increasing the medical costs (Evans, 2012). The delivery and payment model of ACA differs from the traditional approach of reimbursing money...