In 2010, the Affordable Care Act authorized the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS) to establish rules for helping doctors, hospitals and other health care providers to improve coordination of care for Medicare fee-for-service beneficiaries through Accountable Care Organizations (ACOs). Physicians have for decades earned a living based on caring for the sick. But in the new world of health care, physicians more often will be paid based on whether they can keep their patients healthy — and must navigate a system that increasingly includes more “accountable care” payment contracts. CMS finalized the ACO rules on October 20, 2011 (by 2015, 550 ACO’s had been set up in the United States). Care Management/Coordination involves the organization of patient care activities to achieve the delivery of the right health services in the right order, at the right time and in the right setting. Organizing care involves the exchange of information among different participants responsible for the various aspects of care including physicians, hospitals, ancillary providers and community resources. Integrated ACO disseminates information about the development and operation of a care management or care coordination program. It describes the components of care coordination programs and related research about inter-professional collaboration as well as services and software available to support care management, care transitions, continuity of care and other aspects of care coordination.
Physicians in various regions of Texas (Austin, San Antonio, Port LaVaca, Dallas, and Weatherford) formed an organization called Integrated ACO with the following goals:
- Improve the individual experience of care: recognizing that health care centered around individual patient’s needs will improve health outcomes
- Improve population health: taking steps to improve the health status of the population served by the organization
- Reduce growth in the cost of health care for populations: providing appropriate care at the lowest cost possible
Integrated ACO is a network of individual practices of ACO professionals founded by Vipul Mankad, M.D., and Nick Shroff, M.D. The initial physician base was in Midland/Odessa and has since expanded to encompass physicians in Austin, San Antonio, Port LaVaca, Dallas, and Weatherford. Physician and provider participation in Integrated ACO is entirely voluntary. We strive to help physicians in our ACO by providing information and education on how they can best negotiate and implement value-based care payment models, and use this knowledge to the advantage of their practice and for the well-being of patients. Our ACO provides information that can support physicians operating in this new environment, while keeping in mind the importance of maintaining physician leadership of current and future accountable care structures. ACO provides opportunities to Medicare Fee-for-Service beneficiaries to receive high quality care without waste of resources. Beneficiaries who receive care from the ACO physicians retain all rights of traditional fee-for-service Medicare. We will arm you with knowledge and confidence as you consider joining or forming an ACO.
The Integrated ACO program strives to be an innovative Patient-Centered model designed to improve the care of high-risk patients. Through team-based care coordination, data collection and analysis, our model empowers practices to improve the quality of care and reduce overall costs. We feel the program has led to a significant quality improvement for diabetes, hypertension, vascular disease, and kidney disease patients, which has resulted in cost savings. We believe, “the best way to reduce health care costs is to prevent disease, not necessarily just treat it.”