An ACO Overview: What You Need to Know

June 14, 2011

As a new healthcare delivery model takes shape, improving patient outcomes and reducing costs is top-of-mind. One of the initiatives in the Affordable Care Act is the creation of Accountable Care Organizations (ACOs). The goal of ACOs is to increase the value of healthcare for all patients and lead to improved quality of care.

An ACO is a group of providers that follows a healthcare delivery model in which the primary care physician is responsible for coordinating patient care. ACOs are connected by an electronic health record system, or EHR, which is an electronic infrastructure connecting all points of care. ACOs reward providers with incentives for improving quality of care and reducing costs, ensuring that patients stay healthy and avoid costly and unnecessary hospital admissions.

To understand the benefits of ACOs consider how care is often provided today. Typically, it is the patient’s responsibility to keep track of the care received. For instance, if a primary care physician (PCP) suspects a patient has developed breast cancer, the PCP would order tests and even surgery from many different centers of care. Each time the patient goes to a new place, they are required to provide surgical and pathology reports, X-rays, CT scans, lab results and medical history. Often, each of these centers of care will order duplicate procedures rather than rely on the results the patient provides. Each of these duplicate procedures comes with a complicated fee-for-service payment model behind the scenes. With an ACO, this would change. PCPs and affiliated specialists would be responsible for ensuring patients receive only the most necessary tests and keep track of all of the records in the EHR system.

How will imaging be impacted by these changes? Because ACOs will be penalized for excessive imaging use and costs, radiologists will play a greater role advising PCPs on ordering the right test and collaborating with PCPs on appropriate use, working as a team to ensure patient outcomes are improved and at a lower cost.

Helping Improve Care Delivery

The ACO pilot program is set to launch no later than January 1, 2012, but many major providers are already implementing these changes. For example, UnitedHealthcare, AETNA and Wellpoint have selected to work with certain oncologists to coordinate and manage care for cancer patients who are members of their health plans.

“You don’t have to look far to realize that providers and payers of healthcare services have started to address delivery reform at a local level,” said Tom Szostak, manager, Healthcare Economics, Toshiba. “Healthcare’s new concentration on creating value and increasing quality will prove to be much more meaningful than a system that only emphasizes volume and revenues.”

In this ACO environment, increasing the quality of care is even more important. This is where Toshiba comes in. Toshiba’s imaging products provide customers with a complete solution and the operational efficiency and financial performance needed to keep up in this new value-based system.

For more information on ACOs, click here to watch the Conversational Healthcare video, “The ABCs of ACOs,” featuring Szostak, or visit the Toshiba America Medical Systems YouTube page to view all the Healthcare Economics videos.