solved How can the formation of Accountable Care Organizations improve quality

How can the formation of Accountable Care Organizations improve quality of care and make providers more responsible for cost of care? Give an example of a study that has addressed coordination of care and has had documented success. Describe the study and its implications for care.    
Responses
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Accountable Care Organizations (ACOs) are groups of physicians, hospitals, and other health care entities, such as those providing Medicaid ACOs services for behavioral health, home health, and long-term care and support. These organizations voluntarily enter into contracts in which they are held accountable for the quality and cost for the care of a focus population(Rutledge et al., 2019). ACOs are expected to collaborate across service sectors (e.g., inpatient and outpatient, primary and specialty care, physical and behavioral health) to manage and coordinate patient care and provide high-quality care, with the expectation that these activities will reduce use of high-cost services such as inpatient admissions, readmissions, and emergency department (ED) visits, thereby reducing Medicaid cost and overall unnecessary service utilization.
Care coordination has been a common tool for practices in an effort to manage complex patients, yet it remains a challenge in determining the most effective and sustainable model(Williams et al., 2019).
In one study, the effectiveness of care coordination was evaluated based on opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease(Williams et al., 2019). A comparison was also made of the views of those with private insurance representatives in Minnesota.
Emerging form the study were important themes such as: 1) a defined scope of practice, rationale for care, key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained workforce, 4) a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family involvement(Williams et al., 2019). The study implied that stakeholders and insurers from different organizations and backgrounds, all with experience in “COMPASS”, agreed about the main elements of a sustainable model in care coordination as well as the need for health policy reform to sustain this practice.
References
Kessell, E., Pegany, V., Keolanui, B., Fulton, B. D., Scheffler, R. M., & Shortell, S. M. (2015). Review of Medicare, Medicaid, and Commercial Quality of Care Measures: Considerations for Assessing Accountable Care Organizations. Journal of Health Politics, Policy & Law, 40(4), 761–796. https://doi-org.libauth.purdueglobal.edu/10.1215/03616878-3150050
Rutledge, R. I., Romaire, M. A., Hersey, C. L., Parish, W. J., Kissam, S. M., & Lloyd, J. T. (2019). Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts. The Milbank Quarterly, 97(2), 583–619. https://doi-org.libauth.purdueglobal.edu/10.1111/1468-0009.12386
Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. BMC health services research, 19(1), 92. https://doi.org/10.1186/s12913-019-3916-5
2 terr ow) Accountable care organizations (ACOs) were implemented as a system-level approach to address quality differences and curb increasing healthcare costs in the United States, which has earned the attention of policy makers in other countries to favor better management of patients (Wilson et al., 2020). An ACO is a system of physicians and hospitals that share monetary and medical accountability for delivering coordinated care to patients with a collaborative goal of reducing unwarranted expenditure. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of preventing unnecessary repetition of services and averting medical errors (CMS.gov, 2021). The collaborative goal of reducing unwarranted expenditures, appeals to the groups of physicians, hospitals, and other healthcare providers as they share in any savings or in any potential costs when service delivery and cost are compared to historical benchmarks (Wilson et al., 2020). These ACO collaborative agreements stray from the fee-for-service model reducing the risk financial implications from insurers and delivering a heavier burden to the providers with the ultimate goal of reducing costs and improving quality.
Nebraska Health Network (NHN) is a physician-led ACO formed by two health systems and their affiliated physicians and hospitals totaling more than 1,700 providers and utilizing over 35 electronic health record platforms in its hospitals and practices (CMS.gov, 2020). The case study conducted illustrates how the NHN established their system and leveraged it to enhance the coordination of care, quality of care, and lessen costs. NHN sought to design a strategy that would allow it to meet the quality reporting requirements of its value-based contracts and to achieve its performance goals within those contracts and as such, the data management system has significantly improved its key operations, such as quality reporting and performance improvement. CMS.gov, 2020). NHN observed an improvement in its internal quality score after launching the management system and found that combining electronic health record data with claims data allowed for more robust, timelier, and actionable gap lists, which helped teams to improve the quality of care noting that integrating the two data sources provided faster access to clinical data, which originally took three to six months when relying on claims data (CMS.gov, 2020). Through the implementation and coordination of care, providers felt more confident in the reports and, in turn, have helped to guide their point-of-care decisions improving quality of care in real time.
This study exemplifies in reality that, in the majority of situations, larger health systems provide a larger amount of medical and surgical services in a variety of locations than smaller health systems. Coordination, or lack of coordination, throughout the entirety of the health system plays a significant role in the quality of care delivered. In this study the direct patient care was manipulated for better outcomes, not by presenting a new treatment plan or strategy but, by creating an environment that supported communication and collaboration in a real-time application owing to the foundation of an ACO by sharing monetary and medical accountability for delivering coordinated and collaborative care to patients reducing unwarranted expenditure.
References
CMS.gov. (2020). Nebraska Health Network’s data management system for improving quality and reducing costs. CMS.gov Centers for Medicare & Medicaid Services. https://innovation.cms.gov/media/document/aco-casestudy-nebraskahealthnetwork
CMS.gov. (2021). Accountable care organizations (acos): General information. CMS.gov Centers for Medicare & Medicaid Services. https://innovation.cms.gov/innovation-models/aco
Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes and costs: A rapid review. Journal of Health Services Research & Policy, 25(2), 130–138. https://doi.org/10.1177/1355819620913141