Accountable Care Organizations: Similarities Between ACO And Managed Care

The Accountable Care Organizations are a coordinated effort between healthcare providers to ensure the best quality of care delivered to the patients and at the same time at a reduced cost. This means that health care providers will voluntarily come together to form the ACO and patients will be able to get treated by any provider in the organization. Apart from that, it will reward the providers for delivering quality care. Even though the ACOs is comparatively a new concept, but its certain concepts and features are closely related to early managed care organizations (Barnes et al.,2014). Both MCOs and ACOs rely on the creation of physician network, promotion of member health and resource management to control costs. Furthermore, focusing

In the Pioneer ACO pilot program, Medicare will give the ACO a population-based payment worth 50 percent of the estimated cost of care for the payees in the third year of the program if the costs are below the benchmark. Providers will only receive 50 percent of their typical payments in the form of fee-for-service reimbursement, and the ACO will determine what share of the population based payment each provider should receive (Shafrin,2011). The goal of both these project is basically to move towards more integrated care. Medicare put forward a proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot

Both Medicare ACO programs need the ACOs to inform the payee that they are participating the ACOs, and the ACOs will be responsible for reducing the cost for these beneficiaries. A significant difference from traditional HMO, however, Medicare patients can still see any physician they want to see without a referral. Whereas many private managed care plans force patients to choose a primary care provider (PCP), (Shafrin,2011). The shared savings features of ACOs and integration of care, discussed above, provide incentives to keep unnecessary utilization down, and could, therefore, lower costs (Barnes et