Healthcare Reform

We are now in full swing for moving healthcare reform forward. Regardless of how you "feel" about it, there will be changes to the healthcare system, allowing for health care for every one. This is a very debatable and heated topic, so instead of sharing my personal beliefs, I'm just going to post a few facts about the Accountable Care Act. Enjoy!!

- ACA is ~2000 page document

-the managed care plans have already started the ACO work; negotiations have already been decided between hospitals and mged care plans

-ACO: local health care organization with a network of providers such as PCP, specialist, and hospitals that are accountable for the cost & quality of healthcare

-Purpose of ACO is to deliver efficient and coordinated care; rewarded with a financial bonus for achieving performance benchmarks set by CMS (Centers for Medicare & MEdicaid Services) source: Managed Care Magazine, Oct 2010, 12-13

-goal is to deter overuse of services

-Pt Protection & Affordable Care Act (PPACA) refers to an ACO as a legal entity that includes MDs and hospitals with at least 5,000 Medicare lives under contract, has the ability to pay participants, and includes both Medicare and commerical lives (if a pt is hospitalized, the ACO has failed-myth!!!; hospital is used only when necessary)

-Aligning Payment with Quality: ACOrgan. "Health (Medical) Home"; Medicaid established 5-yr ACO in Jan 2012 with pediatric providers (pilot for minimum of 3 yrs); Medicare required DHHS to create a ACO to work together to manage patient cost & quality of care to Medicare beneficiaries; ACOs can include MDs, hospitals, NPs, PAs, and others ; goal sis to work collaborative

Signed,

Your Nurse Leader

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