ACOs (Accountable Care Organizations) work in sync with the Affordable Care Act (colloquially called Obamacare) to redefine the landscape of healthcare in the United States. ACOs aim to reduce healthcare costs for the provider (physician practices/hospitals) and the payer (insurance firms) while also benefiting patients. ACO is a value-based model of healthcare that is in stark contrast to the fee-for-service payment model that is widespread in the U.S. today.
What are the benefits of ACO for stakeholders?
Population health management is the focus of ACOs. This is done by helping patients stay healthy, prevent illnesses, and reduce the frequency of hospital stays and emergency room visits. In the traditional model, physicians and hospitals are paid irrespective of how healthy the population is and given incentives for more procedures and tests. In the ACO model, they are rewarded for helping people stay out of hospital!
What is the future scope for ACO?
In a poll conducted by the State of the Payer Industry Survey, 55% of the total polled medical establishments were moving forward with the ACO model.
How does ACO work?
Accountable Care Organizations are a network of hospitals, physicians, and other providers of healthcare who communicate with each other and work in a coordinated fashion to provide healthcare that is affordable and efficient because it is streamlined and better organized. In an ACO, patients can get access to all the healthcare specialists they need easily, even if they are out of the ACO network. All of these healthcare providers coordinate with each other to ensure that only the most necessary tests and medications are prescribed. This system ensures the elimination of unnecessary spending through repetition of tests and procedures which can happen when healthcare is not coordinated.
What are the cost savings for payers and providers in ACO?
In the first two years of the program’s inception, Medicare saved more than $300 million. In the third year of the ACO program, 97 ACOs shared in a cost savings of more than $400 million.
What are the major challenges faced by clinics and hospitals in joining an ACO?
The number one challenge faced by clinics and hospitals that want to join an ACO network lies in upgrading to the technology that is necessary for ACO to work. For seamless coordination between healthcare providers, there has to be access to accurate health records across the network. For population health management, there has to be access to population data and analysis of that data.
Getting integrated into an ACO network involves a great deal of financial investment to upgrade existing systems and technologies to support health information exchange (HIE)
How does Vee Technologies help payers and providers in the ACO model?
Vee Technologies is a global business process management company that specializes in end-to-end revenue cycle management (RCM). Vee Tech started its journey with leading health insurance companies such as Aetna and Cigna. It now provides RCM services to five out of the top 10 hospitals and healthcare systems listed in USA Today.
Within this framework, Vee Technologies has extensive experience and expertise in providing world-class RCM services to leading hospitals and physician groups in the U.S.
Vee Technologies provides both payers and providers with all the solutions they require to be integrated into an ACO. For the provider side, these are the services that Vee specializes in:
- Inpatient (Facility & Physician) coding
- Professional Coding (Multi Specialty)
- RAF Optimization Services
- PQRS Abstraction/GPRO Reporting
- Eligibility and Benefit verification
- Verify/ Obtain Referral & Authorization
- Charge Entry/Claim Submission
- Payment Posting – EDI & Manual
- Credit Balance Review
- Underpayment Analysis
- Denial Management
- Correspondence follow-up
- Account Receivable Follow-ups
For the payer side, these are the services that Vee has expertise in:
- HCC Coding
- RADV Audit Support
- DRG Validation
By enlisting Vee Technologies to provide these services, clinics and hospitals can take the first step towards joining an ACO. Vee Technologies helps them start sharing in the savings that are passed onto them by Medicare and insurance companies, thus increasing their cost effectiveness and revenue in the long run. The more clinics and hospitals join the ACO network, the more insurance companies and Medicare is able save. Vee Technologies is proud to play a crucial role in facilitating this whole new world of healthcare in the U.S.