The PPACA of 2010
PPACA of 2010 brought many changes to the types of provider organizations available. ACOs and PCMHs are two new organizations formed under PPACA. Using the readings this week, discuss the origin, structure, and purpose of the new organizations formed under PPACA.
Using South University Online Library (for example, CINAHL) or the Internet, search three articles from the list below and evaluate the challenges and opportunities facing payers and providers as ACOs and PCMHs are implemented:
Baird, M. A. (2011). The patient-center medical home and managed care: Times have changed, some components have not. The Journal of the American Board of Family Medicine, 24(6), 630–632. Retrieved from South University Library at: http://www.jabfm.org/content/24/6/630
Bolin, J. N., Gamm, L., Vest, J. R., Edwardson, N., & Miller, T. R. (2011). Patient-centered medical homes: Will health care reform provide new options for rural communities and providers? Family & Community Health, 34(2), 93–101.
Goldsmith, J. (2011). Accountable care organizations: The case for flexible partnerships between health plans and providers. Health Affairs, 30(1), 32-40. Retrieved from: https://search-proquest-com.southuniversity.libpro…
Goroll, A. H., & Schoenbaum, S. C. (2012). Payment reform for primary care within the accountable care organization a critical issue for health system reform. JAMA: The Journal of the American Medical Association, 308(6), 577–578. Retrieved from: http://jamanetwork.com.southuniversity.libproxy.ed…
Longworth, D. L. (2011). Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Cleveland Clinic Journal of Medicine, 78(9), 571–582. Retrieved from South University Library http://www.mdedge.com/ccjm
Singer, S., & Shortell, S. M. (2011). Implementing accountable care organizations: Ten potential mistakes and how to learn from them. JAMA: The Journal of the American Medical Association, 306(7), 758. Retrieved from South University Library http://jamanetwork.com.southuniversity.libproxy.ed…
Based on your research, summarize your findings on the selected topics and compile your observations in a 5- to 6-page Microsoft Word document that includes an introduction and conclusion.
Expert Solution Preview
Introduction:
The Patient Protection and Affordable Care Act (PPACA) of 2010 introduced two new healthcare provider organizations- Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). These organizations were established to improve healthcare quality, lower costs, and increase access to care. This paper will discuss the origin, structure, and purpose of ACOs and PCMHs, followed by an evaluation of challenges and opportunities facing payers and providers in the implementation of these organizations.
ACOs and PCMHs:
ACOs are groups of healthcare providers, including hospitals, doctors, and other healthcare professionals, who work together to deliver coordinated care to patients. They are responsible for managing the health of a designated patient population, meeting quality standards, and reducing healthcare costs. PCMHs, on the other hand, focus on providing comprehensive, patient-centered primary care that is accessible, coordinated, and continuous. They provide a team-based approach to care, including physicians, nurses, pharmacists, and other healthcare professionals, who work collaboratively to address the physical, behavioral, and social needs of patients.
Challenges and Opportunities:
Various challenges and opportunities arise in the implementation of ACOs and PCMHs. One significant challenge is the integration of these organizations with existing healthcare systems, particularly regarding payment and reimbursement mechanisms. ACOs and PCMHs require significant investments in care coordination and technology infrastructure to facilitate information exchange and patient engagement. In addition, the successful implementation of these organizations requires significant cultural shifts, including changes in physician practices and patient expectations.
Despite the challenges, ACOs and PCMHs represent significant opportunities for payers and providers. The formation of ACOs can effectively align incentives between payers and providers, promoting the provision of higher quality, cost-effective care. The integration of PCMHs can lead to better care management and improve medication adherence, reducing the likelihood of hospitalizations and emergency department visits. Both of these organizations may lead to increased access to care, particularly in underserved and rural areas, where the coordinated care model may enhance healthcare delivery overall.
Conclusion:
In conclusion, the emergence of ACOs and PCMHs represents a significant shift in how healthcare delivery is organized and financed. The successful implementation of these organizations requires significant investments in care coordination, technology infrastructure, and cultural shifts. However, despite the challenges, these organizations offer significant opportunities for payers and providers to improve patient outcomes, reduce costs, and increase access to care.
