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Phoenix Forward

Can health care reform improve patient care?

Can health care reform improve patient care?

The key to better care may be in Accountable Care Organizations

Health care in America is challenged by rising costs, a large under- or uninsured population, and the threat of an increased burden of providing care as baby boomers age. As a nation, we spend nearly 16 percent of our economy on health care each year ($2.2 trillion in 2010), yet our treatment outcomes fall short of other countries, says the U.S. Department of Health and Human Services (HHS).

The Affordable Care Act was passed in March 2010 to help ease costs while making quality health care accessible to all Americans. Can this reform bill improve the quality of patient care while keeping costs in check?

Accountable Care Organizations (ACOs)

An important element of the Affordable Care Act is the formation of ACOs, single organizations that deliver comprehensive care to Medicare beneficiaries.

ACOs are scheduled to go into effect in January 2012, but several states have already begun forming them. Alacey Beruman, PhD, University of Phoenix faculty member and area chair for the health administration program, explains why. “Some states have already adopted ACO — New Hampshire, Arizona and Colorado," Beruman says. "About 14 states view ACO as a welcome change. Some of the states aren’t limiting care to just Medicare patients; they’re applying it to their entire network of patients.”

Here’s how ACOs work: Hospitals and doctors — from general practitioners to cardiologists to mental health doctors and others — form ACOs to work together to manage the health of at least 5,000 Medicare beneficiaries for a minimum of three years. Doctors will receive bonuses for meeting quality care standards established under the Affordable Care Act, which ensures quality care is an organizational goal.

Patients receive care from providers in their ACO who have access to their patient history. They receive continuous care while the costs of referrals and redundant testing are reduced.

How ACOs reduce health care spending

Under today’s system, redundant testing is common. According to Berumen, it’s mostly due to patient information privacy restrictions granted under the Health Insurance Portability and Accountability Act (HIPAA). “I work in an emergency room, and unless the patient signs a waiver, the emergency room physician can’t talk to a primary care physician. So the doctors are rerunning labs, and this duplication of services drives up health care costs.”

All ACO health care providers will have access to patients’ health records, which saves time and could help eliminate mistakes caused by gaps in knowledge due to HIPAA restrictions.

This program needs additional funding for it to begin, but it will be worth it to have more accessible, quality health care. Besides, HHS estimates that the ACO program can save taxpayers up to $960 million over the next three years.

“Although it’s an investment up front, it’s also an investment in the health of our country,” Berumen explains. “People who have health conditions are less productive because they’re dealing with their health. It has an impact on their families, their employers and their community. If we could be a healthier country, then maybe we could be more competitive globally.”

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