The ACO model focuses on a coordinated and patient-centered care system. ACO models are "meant to allow providers to break away from the tyranny of the minute visit, instill a renewed sense of collegiality, and return to the type of medicine that patients and families want.
In order to verify that these goals are being accomplished, CMS requires ACOs to provide proof of quality and patient satisfaction, as well as numerically tracking chronic disease prevention and management. ACOs require strong leadership and coordination to be successful, and can in turn provide infrastructure and benefits to the PCMH model.
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Support Learn more about personalized support and consulting. Contact Get in touch for more information. Resource Center Grow Your Practice with industry insights and up to date knowledge. This review will examine newly proposed models of healthcare. Recent findings: The patient-centered medical home PCMH and accountable care organizations ACOs are two models that have leapt to the forefront of healthcare reform. The PCMH or medical home is a model predicated upon a primary care provider who will provide and coordinate comprehensive healthcare for the patient across the continuum with care that is evidence based and patient centered.
The PCMH provides coordinated care, allowing for more appropriate utilization of resources resulting in improved care and outcomes while decreasing costs. A strong primary care workforce including physicians, physician assistants, nurses, medical assistants, nutritionists, social workers, and care managers is a critical element of the PCMH model.
Amid a primary care workforce shortage, it is imperative to develop a workforce trained to provide care based on the elements of the PCMH. Current fee for service payment policies are inadequate to fully achieve PCMH goals.
Providers are not routinely compensated for care coordination or enhanced access, contributions of the full team are often not reimbursed, and there is no incentive to reduce duplication of services across the care continuum.
Payment reform is needed to achieve the potential. The website accountablecarefacts. February 4, Related: Private payers re-examining reimbursement Both approaches also require patience and determination-as well as substantial resources to implement and to make function effectively.
In general, however, PCMH describes a practice that: treats patients holistically, provides patients with extended access to providers, provides team-based care, effectively coordinates care with other providers, focuses on quality and safety, and engages patients in their own care A study by the Medical Group Management Association found that many organizations and payers have created standards for designating a practice as a PCMH, but only four-the Accreditation Association for Ambulatory Health Care , the Joint Commission , the National Committee for Quality Assurance , and URAC had PCMH programs that were national in scope, PCMH-specific, had a published set of standards, and were used widely as a model PCMH.
Patient-centered care Delivering primary care that is oriented towards the whole person. Coordinated care The PCMH coordinates patient care across all elements of the healthcare system, such as specialty care, hospitals, home healthcare, and community services, with an emphasis on efficient care transitions. Accessible services The PCMH seeks to make primary care accessible through minimizing wait times, enhanced office hours, and after-hours access to providers through alternative methods such as telephone or email.
Quality and safety The PCMH model is committed to providing safe, high-quality care through clinical decision-support tools, evidence-based care, shared decision-making, performance measurement, and population health management.
Achieving the goals of the PCMH model requires aligning three vital components: Health information technology Health information technology IT can support the PCMH model by collecting, storing, and managing personal health information, as well as aggregate data that can be used to improve processes and outcomes. Workforce A strong primary care workforce including physicians, physician assistants, nurses, medical assistants, nutritionists, social workers, and care managers is a critical element of the PCMH model.
Possession of sufficient infrastructure and management acumen to support comprehensive, valid, and reliable performance measurements; to make internal system improvements in care quality; and to externally report on its performance with regard to cost and quality of care.
A clear organizational mission and commitment to achieve quality and cost efficiencies; a physician management structure that is supportive of all of the requirements listed above; and a culture that supports and rewards continuous quality improvement. The use of health information technology to manage patients across the continuum of care and across different institutional settings, including at least ambulatory and inpatient hospital care and possibly post-acute care.
Want to join an ACO? What are the administrative and organizational requirements to participate for instance, pertaining to data submission, committee participation, etc.
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