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How Medicare Can Achieve Saving through ACA/ACO

How Medicare Can Achieve Saving through ACA/ACO

It is extrapolated that the enrollment of Medicare Patients into a particular ACO such as the ACO associated with Gotham will result in cost savings by Medicare. This savings will be achieved through improved services that will lead to efficient care. Some of the strategies that will lead to cost savings through the ACO include:

• Coordination of care: as highlighted earlier, it is anticipated that co-ordination of care amongst the various members of the ACO structure will lead to integrated care that will eliminate redundancies. Some of these redundancies manifest themselves as repetition of investigations already performed by a particular provider and lack of proper communication between providers in managing a particular patient. One of the ways various providers in a particular ACO unit will have access to patients’ information is the use of HIPPA-compliant HIT structure in which every patient has a particular Identifier Code that each members of the ACO could use to access the patients’ information. In the case of Gotham ACO unit, all members of the structure can remotely access patient’s data through the Bronx RHIO [define and discuss] which provides a centralized EMR digital access to all associated ACO’s. This provides savings to Medicare through both reduced administrative cost and reduced cost of redundant investigations.[this is the main point about ACOs. Discuss this more with supporting documentation]

• Bundled Payment: again, as earlier highlighted, under the ACA/ACO, CMS has a contractual agreement for bundled pay per episode of care. Due to this mode of payment, the ACO will have to co-ordinate care across multiple spectrums of care settings from inpatient Physician services, hospital and clinics to post-acute and post admission care for insured patients. This will also involve preadmission preventive services that will discourage avoidable admissions. All members of the ACO unit have a common interest in ensuring that enrolled members do not develop any form of preventable disease. Thus, this method of payment introduces accountability across various spectrums of providers with common interest in saving cost since they all receive payment per episode of care rendered. This elimination of fragmented care as highlighted can potentially save money for Medicare by having a healthier population of enrolled patients. (NCSL, 2013)

• Better reimbursement coordination: The ACO provides an overarching legal structure for CMS and other third- party insurers to co-ordinate reimbursement of providers. The ACO provides direct contraction by payers with providers without reliance on healthplan intermediaries such as Managed Care Plan. In this capacity, The ACO provides Medicare and Private Insurance companies with a vehicle for implementing comprehensive payment reform that can potentially save administrative cost through efficiency.[is this true?]

All these factors put together can potentially control the cost of healthcare while also getting a better value for every dollar spent on healthcare (NCSL, 2013)


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