Accountable care organizations (ACOs) are designed to promote value and quality in health care. They use new payment and delivery models that include incentives to improve care coordination and utilization management. With these models, ACOs contract with private insurers and/or Medicare to receive reimbursement, and then the ACO determines how to contract with physicians and other medical providers to provide health care services to patients. Since not all providers are direct employees of ACOs, there are potential challenges with reimbursing the affiliated providers in a way to maximize efficiency, increase quality, and lower utilization. For this Discussion, examine the following scenario and recommend strategies for reimbursement and utilization management. 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?

You have been invited to assemble a task force to design a medication assistance program. You need to submit a proposal, regarding who you would invite, to the CEO. Consider the perspectives of prescribers, discharge planners, financial navigators, patients, suppliers, book keepers and subsidizers. If you were to seek the input of 5-7 stakeholders, who would you invite to the planning table, and why? Consider the need for a group facilitator. Who would that person be, and why?Submit a 2-3 page APA 7th edition style response to this query. Open with a paragraph of purpose, dedicate a paragraph to each stakeholder that you would invite, and close with a summary of what you hope to accomplish with the group, within a designated time frame. Include a cover page and a reference page.