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More than half of Americans now have access to Accountable Care Organizations

By Catholic Online (NEWS CONSORTIUM)
February 19th, 2013
Catholic Online (www.catholic.org)

Often referred to as "Obamacare," the 2010 Patient Protection and Affordable Care Act required Accountable Care Organizations to form last year and provide quality value-based affordable health care as an alternative to today's fee-for-service system. The Oliver Wyman consulting firm now suggests that more than half of Americans now have access to an ACO.

LOS ANGELES, CA (Catholic Online) - ACOs are intended to lessen health care costs by pushing for high quality and less expensive treatment, in contrast to today's payment structure that often leads doctors to recommend costly procedures, that are not always necessary - or necessarily better.

Insurance companies then typically pay for more expensive procedures at a more frequent rate. In response, ACOs are expected to only recommend treatment that is necessary. Providers in an ACO receive cash rewards if they keep their patients out of more costly hospitals.

Forbes reports that ACOs began to provide medical care services to seniors through contracts with the Medicare health insurance program for the elderly last year. Private health insurance companies such as Aetna, Cigna, Humana, UnitedHealth Group, and Blue Cross plan to link with ACOs to extend care to more patients.

Around 40 million Americans are already in organizations with ACO arrangements. This is an increase from around 30 million last fall. A report by Oliver Wyman shows that ACOs are most numerous in the Southwest, the Midwest, the Northeast and Florida. Access is lowest in a path of states stretching across the country from Washington, Oregon, and Idaho down to Louisiana, Alabama, and Mississippi. Fifty-two percent of the population now lives in areas served by ACOs, up from 45 percent in August.

An accountable care organization is defined by the online encyclopedia Wikipedia as a healthcare organization characterized by 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. A group of coordinated health care providers forms an ACO, which then provides care to a group of patients. The ACO may use a range of payment models (capitation, fee-for-service with asymmetric or symmetric shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness and efficiency of the health care provided.

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