MDS's vast experience in physician alignment planning, strategic organizational development, physician compensation, and primary care strategy uniquely qualifies MDS to assist an organization in determining ACO readiness. As the discussions about the particulars of the healthcare reform legislation continue to be discussed and debated in Congress, the Department of Health and Human Services, and the Centers for Medicare and Medicaid Services, new concepts, healthcare strategies and business models continue to arise.

One of these emerging concepts is an Accountable Care Organization ("ACO"). The ACO is defined as an organization of healthcare providers that agree to be accountable for the quality, cost, and the overall care of Medicare beneficiaries assigned to it who are enrolled in the traditional fee-for-service program. The goal of the ACO is to manage the full continuum of care and be accountable for the costs as ACO Preparation and Development. The Patient Protection and Affordable Care Act (PPACA) created ACO, which will be a new part of Medicare as of January 2012. The focus of the ACO is on both quality and cost control, including a bigger picture of health care delivery systems and all other payers on a state and private level.

ACO's are designed to improve quality of care, reduce medical errors, decrease the rate of rising health care costs, and create savings in federal healthcare expenditures.

Qualifying ACO entities:

  • Large integrated delivery networks systems (IDNs)
  • Physician–hospital organizations (PHOs)
  • Multi-specialty practice groups with or without hospital ownership
  • Independent practice associations (IPAs)
  • Virtual interdependent networks of physician practices

Some of the key theories/concepts behind ACOs include:

  • Coordinated care improves quality and reduces cost
  • Models should be physician-driven
  • Reduces volume incentives for health care providers and payers
  • Coordinated care includes Primary Care Medical Homes ("PCMH") and population management
  • Primary care and condition management by care teams are the "secret" to reducing cost and simultaneously improving quality
  • Gain sharing in episodic care management and capitation will provide savings that can keep participating providers whole
  • Medicare patients will be moved to high volume/high quality/lower cost centers

Because of the nature of unknowns related to ACOs and the inevitable continued changes, organizations are rushing to best prepare themselves for the delivery system overhaul. The task is daunting and MDS can make it easier by assessing the organizational readiness for becoming an ACO. From clinical integration strategies, primary care network development, governance models, and alignment structures, we have tools and systems in place to help you better understand your future positioning.

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