Bloomsburg University Accountable Care Organizations Discussion

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Bloomsburg University of Pennsylvania

Description

Scenario:
Medicare and private payers have expanded reimbursement under Accountable care organizations (ACO). You are the chief financial officer (CFO) of a hospital system that is forming an ACO to participate in these payment models. The ACO seeks to improve care coordination for its patients with chronic conditions. To provide better care management, the ACO is interested in investing in primary care physicians and physician’s assistants to provide more intensive care management services. After formation, the ACO will enter contracts with Medicare and private insurers under alternative payment models, including shared savings, bundled payments, and global capitation. The ACO will need to determine how to set up reimbursement payments to ACO providers and consider whether financial incentives are required to ensure ACO providers deliver efficient care.

To prepare for this Discussion:

  • Read the provided scenario.
  • Consider strategies for reimbursement and utilization management, including financial incentives.
    • How might you set up the reimbursement payments to ACO providers, considering the alternative payment models (i.e., fee for service, shared savings, bundled payments, or global capitations)?
    • What utilization management controls might you add to align the interests of ACO providers?


Post a cohesive response to the following:

As the CFO of the ACO in the provided scenario, recommend strategies for reimbursement and utilization management. Defend your recommendations.


QUESTION 2

The Assignment:

In a 2- to 3-page Word document that includes tables and/or calculations, make recommendations on the following: 1) number of physicians and nurse practitioners needed; 2) reimbursement method: salary or fee-for-service; 3) recommendations for financial incentives to address the challenges of supplier-induced demand and how to ensure efficiency. Interpret the net profit from the ACO contract based on your recommendations. Explain the rationale behind your recommendations, including the impact made by your financial calculations.

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Explanation & Answer

Attached.

Running Head: ACO PROGRAM

1

Accountable Care Organizations
Student's Name
Institution Affiliation

ACO PROGRAM

2
Accountable Care Organizations

Accountable Care Organizations consist of hospitals, physicians, and specialists that
voluntarily offer to share the financial responsibility with a payer to ensure the patient's
coordinated care. They deliver quality care at the required time helping in reducing unnecessary
utilization of services.
The ACO can come up with a way to manage risks while optimizing on the rewards.
Changes in the insurance sector should be able to give members quality services. For instance,
eliminating copays for diabetic patients may improve compliance with medication and treatment.
In addition to this, to make better decisions about their health, patients need to have adequate
access to data. The data may be on the available services and their costs. Patient portals and
some mobile applications provide the ideal forum for patients to access this data. Therefore,
there will be a need to invest in technology (Graber et al, 2017).
Setting up reimbursement payments to ACO providers.
All payment models have their advantages and disadvantages to the provider
organizations; therefore, the payment model should be easy to understand so that the ACO
providers get interested in improving the delivery of care. It is for this reason that, as the CFO, I
find it prudent for our hospital system to adapt the shared savings payment model. In this,
method providers are in a position to share in a portion of the savings they get. This helps in
benefiting the providers as they only have to deal with upside risk. They do not have to take p...


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