Accountable Care Organizations

Healthcare organizations that are characterized by a payment and care delivery model that ties provider reimbursements to quality, low-cost care.

What is an accountable care organization?

An accountable care organization (ACO) is a healthcare organization that provides a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Typically, a group of coordinated health care providers come together voluntarily to form an ACO, which then provides care to a group of patients. The goal of an ACO is to provide coordinated, high-quality care to patients while ensuring that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services. When an ACO succeeds in delivering high-quality care and spending health care dollars more wisely, it shares in the savings it achieves.

High quality, preventative care.

The accountable care organization model is accountable to patients and the third-party payer for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, ACOs agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries. ACOs have extended this promise to third-party payers as well.

According to Mark McClellan, Elliott Fisher and others, there are three core principles to an ACO:

1) Provider-led organizations, with a strong base of primary care, that are collectively accountable for quality and total per capita costs across the full continuum of care for a population of patients;

2) Payments linked to quality improvements that also reduce overall costs; and,

3) Reliable and progressively more sophisticated performance measurement, to support improvement and provide confidence that savings are achieved through improvements in care.

According to CMS estimates, ACO implementation as described in the Affordable Care Act is estimated to lead to an estimated median healthcare cost savings of $470 million from 2012–2015.

Proactive care for the accountable care organization with Glooko.

Monitor Pop Tracker v2

In order to deliver on the promise of higher quality care at lower costs, ACOs will need to invest in innovation, technology and processes that drive efficiency and provide better access to population and patient-level health data. While the Electronic Health Record (EHR) has been widely adopted by ACOs, these applications tend to lack domain-specific depth and integration with a vast array of devices that are used to manage diabetes. That’s where Glooko comes in. With Glooko, patients and ACO providers can proactively capture, monitor and drive action based on diabetes-specific data. Glooko brings together the complex world of diabetes data (blood glucose readings, diet, biometrics, exercise) into a unified platform so that care providers can manage their population of patients, identify at-risk patients and aims to PREVENT issues before they become costly interventions or visits to the hospital.