Accountable Care Organizations: An Integrated Model of Patient Care Objectives

Rick Panning

doi:10.29074/ascls.27.2.112

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Rick Panning, MBA, MLS(ASCP)^CM⇑
1. Chair, ASCLS Government Affairs Committee ^, Director of Business Development for Shared Clinical Services, Fairview Health Services, Minneapolis, MN

Address for Correspondence: Rick Panning, MBA, MLS(ASCP)^CM, 4894 Meadow Lane, Shoreview, MN 55126, 651-280-5909, panning4{at}comcast.net.

Describe how the traditional pre-analytical, analytical, post analytical model of laboratory testing will be transformed in the Accountable Care Organization model.
Describe the role of the clinical laboratory in the Accountable Care Organization model.
Describe how transitions in the health care process (i.e. discharge, transfer, etc.) add to cost and reduce quality, and how the Accountable Care Organization model is intended to address these inadequacies.
Delineate the differences in the three primary Accountable Care Organization models as defined in the Affordable Care Act: Medicare Shared Savings, Advanced Payment Model and Pioneer Accountable Care Organization.

Extract

Introduction As a component of the Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA), for short, Accountable Care Organizations (ACO) have an ultimate goal of improving quality and patient care outcomes through coordinated care, thereby reducing the total cost of healthcare. Healthcare reform and the ACO model will shift healthcare resource allocation from acute care to an intense focus on preventive care, wellness, chronic disease and managing transitions. Because of the aging population and the increase in chronic disease, the following statistics have a significant impact on healthcare costs in the coming years.¹

Seventy eight percent of the total healthcare spend in the U.S. is attributable to chronic disease. Just 5% of patients, account for greater than 50% of the total U.S healthcare expenditures. In contrast, nearly 50% of the U.S. population accounts for just 3% of total U.S. spend. Hospitals account for 31% of the total spend while medications account for 23%. The outpatient laboratory spend is approximately 3.8% of the healthcare spend in this country. As you can see from these statistics, the laboratory is not the problem, but with healthcare reform and the ACO model, laboratories can be a significant part of the solution.¹

The ACO model is projected to save $4.9 billion over the first ten years of implementation. As defined in Section 3022 of the ACA, an Accountable Care Organization is a group of providers who are “accountable for the quality, cost and overall care” of patients. ACOs are essentially partnerships…

ABBREVIATIONS: ACA – Affordable Care Act; ACO – Accountable Care Organization; CMS – Centers for Medicare and Medicaid Services; CPOE – Computerized Physician Order Entry; EMR – Electronic Medical Record; GDP – Gross Domestic Product; IDS – Integrated Delivery Systems; PCMH – Patient-Centered Medical Home; PPACA – Patient Protection and Affordable Care Act

Describe how the traditional pre-analytical, analytical, post analytical model of laboratory testing will be transformed in the Accountable Care Organization model.
Describe the role of the clinical laboratory in the Accountable Care Organization model.
Describe how transitions in the health care process (i.e. discharge, transfer, etc.) add to cost and reduce quality, and how the Accountable Care Organization model is intended to address these inadequacies.
Delineate the differences in the three primary Accountable Care Organization models as defined in the Affordable Care Act: Medicare Shared Savings, Advanced Payment Model and Pioneer Accountable Care Organization.