Managed Care Organizations: A Case Study
Even though, the ACOs is comparatively a new concept but its certain concepts and features are closely related to the managed care organizations (Barnes et al.,2014) Taking in to consideration the Health Maintenance Organizations (HMOs), and in performance improvement programs such as pay-for-performance (P4P) and patient-centered medical homes (PCMHs). HMOs are the strongest form of managed care, in that they require patients to stay within the provider network and they incentivize providers to reduce unnecessary care through reimbursements and other mechanisms. Care is typically managed through the use of practice guidelines, prevention, and disease management (an integration of care for complex and chronic diseases) (Barenes.et.al,2014).
And taking in to consideration the ACOs, its features resembles the HMO model. ACOs in the Medicare program control costs through bundling of charges and “shared savings”, which come from either bonuses, or withholds with bonuses for good performance. One way the ACO control costs by its network of doctors and hospitals and they share medical and financial responsibility and overall a more coordinated care to patients which will provide cost savings. ACOs also share certain similarities between managed care plans like pay-for -performance plans and PCMH models. In P4P is based on financial incentives are often aligned with clinical care delivered by the primary care physicians. ACO quality-improvement mechanisms are similar to these P4P programs that reward ACOs for providing high quality care. If we take the case of the PCMH, it focuses on individuals with one or more significant chronic illnesses. And it aims to a more coordinated form of care for those individuals with multiple co-morbid conditions. ACOs’ model of integration care is borrowed from PCMH concepts of coordinating patient care.
And taking in to consideration the ACOs, its features resembles the HMO model. ACOs in the Medicare program control costs through bundling of charges and “shared savings”, which come from either bonuses, or withholds with bonuses for good performance. One way the ACO control costs by its network of doctors and hospitals and they share medical and financial responsibility and overall a more coordinated care to patients which will provide cost savings. ACOs also share certain similarities between managed care plans like pay-for -performance plans and PCMH models. In P4P is based on financial incentives are often aligned with clinical care delivered by the primary care physicians. ACO quality-improvement mechanisms are similar to these P4P programs that reward ACOs for providing high quality care. If we take the case of the PCMH, it focuses on individuals with one or more significant chronic illnesses. And it aims to a more coordinated form of care for those individuals with multiple co-morbid conditions. ACOs’ model of integration care is borrowed from PCMH concepts of coordinating patient care.