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Changing the Delivery of Healthcare: Are ACO's the Answer?

During a recent Healthcare symposium sponsored by Progressive Benefit Solutions and BCBS of NC there was much discussion about the need for a transformation of healthcare delivery.

Two staggering statistics:

  • Healthcare spending is now approximately 17% of the U.S. GDP and growing at an unsustainable rate.  
  • The U.S. mortality rate ranks 38th in the world for developed countries and we spend on average 4 times more in healthcare dollars than the countries ranked ahead of us.

The bottom line is we need new ways of delivering healthcare that are easier to navigate, more efficient, have better outcomes and are less expensive.

One possible solution are the Accountable Care Organizations or ACO«¤??s, they are designed to provide the patient with coordinated medical care regardless of the place of service.  In this arrangement, the hospital, physician group or Home Health Agencies are reimbursed based on outcomes.  The result and driving interest, providers that are more efficient share in the savings with the employer, insurance carrier or Medicare.

This April Medicare(CMS) announced that 27 ACO's serving roughly 375,000 patients in 18 states will be eligible to participate in a shared savings program if certain standards and quality metrics are met. BCBSNC and UNC Health System recently opened an ACO in Chapel Hill to treat patients with chronic medical conditions in an effort to determine if costs can be reduced with true coordinated care.

These are interesting trends that we are exploring and implementing with our clients and we believe will be the future of healthcare delivery in the US. The PBS team is actively involved in creating solutions for our clients and working daily to help manage the rising healthcare costs of our current delivery system. ACO's, Patient Centered Medical Homes, tiered networks and creative plan designs are a few of the strategies we utilize with our clients. Regardless of the Supreme Court decision on the constitutionality of The Affordable Care Act our current system has to change and become a more efficient, cost effective and value based healthcare delivery system.

Posted June 21, 2012

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