Healthcare – Looking forward to a better tomorrow!

The US Healthcare System consumes a large share of the national GDP which is many times more than any other country on healthcare expenditure; despite lavish investments, the system is struggling to meet parameters like population health and improved quality of care. How can countries provide improved health in a cost-effective manner? Find out more!

The idea of Affordable Care Act was the key remedy to this disparity.

The act aims to shift focus on US healthcare system to enhance the quality of care, simultaneously decreasing the costs that are incurred. The act has thus turned a new leaf in medicine and has created new models of care delivery to cater to the needs of today. One of which is Accountable Care Organization or ACO.

The Accountable Care Organizations are a network of doctors, hospitals and other healthcare professionals who are willing to share resources and responsibility for providing patient-centric coordinated care. Although ACOs’ are part of a shared saving scheme and is also an incentive for providing coordinated care.

The ACOs’ is envisioned to be the foundation on which the new era of cost-efficient care will be built, but some hurdles stand in the way of ACOs and their destiny, following are a few prominent problems:

1. Managerial Challenges:

Many ACOs are run by physicians themselves which means all the paperwork, coordination activity and calculating compensation rest on the shoulders of the physicians. These problems are further amplified in case the ACO lacks a well-defined leadership structure and reporting channel.

Outsourcing operational functions can improve operational performance, but this could mean relinquishing self-governance and physician leadership – two essential qualities of ACOs. Hence, it is important for ACOs to choose a system best suited to its nature and needs.

2. Leveraging on Capabilities:

Different caregivers use different EHR systems, and most of them do not have inter-operating capabilities. The ability to generate and securely share patient information is critical for an ACO to reduce redundancy, and achieve its objectives.
In the absence of an interoperable system, physicians cannot coordinate to ensure continuity of care. For ACOs to be successful they have to function as a single entity providing care. The ACO needs to work on a single EHR system or employee interoperable solution to help the EHRs communicate with each other.

3. Ever-Changing Payment Rules:

The Center for Medicare and Medicaid (CMS), under whose authority a sharing scheme is initiated, may alter or even introduce new schemes and rules sometimes even without much warning. As ACOs grow in efficiency, CMS will adjust the saving targets accordingly and ACOs will find it increasingly difficult to make savings. The ACOs must maintain a flexible operating system to have the ability to turn change into opportunity.

4. Getting More Patients to Participate:

The health of a population cannot be guaranteed without the participation of the population itself. To sidestep this obstacle, the ACOs need to redefine its population to include not only registered patients but also the whole community they serve. Key initiatives should be taken by the ACO to engage the population it serves.

A Stronger Foundation For Tomorrow:

A single step cannot solve a complex problem in a healthcare sector that is usually procedure driven. The ACOs should look for a plausible solution rather than a sufficient answer. The team of practitioners should look at a set of healthcare solutions and focus in the right direction to provide high-quality and cost-efficient health.

Leave a Reply