ACOs & HME
ACO, the acronym for an Accountable Care Organization, is a buzzword these days in the health care industry. Nearly everybody has heard the term by now. Many are wondering, what does it mean to medicine, and more importantly, what does it mean to HME providers?
Here are the basics.
Medicare ACOs are a product of the Affordable Care Act, and were conceived in an attempt to find a solution meeting former CMS Administrator Don Berwick’s “Triple Aim” vision for health care reform:
- Improve the experience of care.
- Improve the health of groups of people.
- Reduce the per capita costs of health care.
An ACO, in concept, is simple. A group of medical providers—including hospitals, physicians groups and suppliers—unite as a single legal entity. Its goal is to collaboratively improve care, reduce use of the Medicare system and improve outcomes.
The ACO concept has garnered widespread bi-partisan support on Capitol Hill. Perception among health care professionals, however, is mixed.
Many associations have supported the concept, with some of the nation’s largest and most popular health systems investing millions. Meanwhile, other equally popular organizations and associations have voiced reservations.
Nonetheless, CMS is moving forward, and has already identified 32 health systems as “Pioneer” accountable care organizations. More than 200 other systems have taken steps to potentially participate in the next phase of the program.
ACOs are measured on 33 core outcomes and satisfaction measures, as well as historical utilization data. If they can improve outcomes while reducing length-of-stay averages, re-hospitalization rates, redundancies in testing and improve other measures, Medicare will share the savings with the ACO.
Implementation of a program like this, however, might not be so simple, even though health care providers have been granted great flexibility to develop ACO models. They have the incredible task of developing a new infrastructure, setting egos aside and finding new ways to deliver health care.
ACOs require integrated electronic health records, collaboration among providers who have traditionally competed for the same dollars and support and buy-in from every level of the health care spectrum. It’s a tall order, but hundreds of health systems and many private insurers are seemingly prepared to try to make it work.
ACOs and HMEs
So where does the HME supplier fit into the ACO model?