Charleston Accountable Care Organization

An Accountable Care organization is a new entity, created from the Health Care Reform law (PPACA).  The concept is yet another in a long string of “hopeful” solutions to the constantly rising cost of care.  This one has promise, but so did the advent of Health Maintenance Organizations (HMO), PPO’s, POS plans, and a host of other proposed “magic Bullets.”  We can only hope.

The concept is that providers (hospitals, doctors, labs, etc) team up with insurance companies, using technology, to better manage both the outcome and cost of patient care.  In its classic form, the ACO gets paid a fixed cost to manage your condition – regardless of outcome.  No more extra billing if they have to redo tests, or a procedure.  No extra illing for another set of xrays or MRI’s.  The focus shifts to a quality of care focus- doing the right tests, the right procedures, at the right time.  If the ACO gets it right the first time they make money.  If they don’t they may lose money. 

A number of successful examples of this approach already exist, and so it is the hope that the Accountable Care Colation of TriCounties, a recently formed ACO venture between United Physicians and Collaborative Health Systems (a technology company).  The venture is aimed at improving the care for Medicare Patients, with the hope of extending proven approaches to the larger population.  They are one of the 88 ACO’s nationally approved and participating in the medicare Shared Savings Program.