Abstract
Accountable Care Organizations (ACOs) seek sustainable innovation through the testing of new care delivery methods that promote shared goals among value-based health care collaborators. The Morehouse Choice Accountable Care Organization and Education System (MCACO-ES), or (M-ACO) is a physician led integrated delivery model participating in the Medicare Shared Savings Program (MSSP) offered through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The MSSP establishes incentivized, performance-based payment models for qualifying health care organizations serving traditional Medicare beneficiaries that promote collaborative efficiency models designed to mitigate fragmented and insufficient access to health care, reduce unnecessary cost, and improve clinical outcomes. The M-ACO integration model is administered through participant organizations that include a multi-site community based academic practice, independent physician practices, and federally qualified health center systems (FQHCs). This manuscript aims to present a descriptive and exploratory assessment of health care programs and related innovation methods that validate M-ACO as a reliable simulator to implement, evaluate, and refine M-ACO’s integration model to render value-based performance outcomes over time. A part of the research approach also includes early outcomes and lessons learned advancing the framework for ongoing testing of M-ACO’s integration model across independently owned, rural, and urban health care locations that predominantly serve low-income, traditional Medicare beneficiaries, (including those who also qualify for Medicaid benefits (also referred to as “dual eligibles”). M-ACO seeks to determine how integration potentially impacts targeted performance results. As a simulator to test value-based innovation and related clinical and business practices, M-ACO uses enterprise-level data and advanced analytics to measure certain areas, including: 1) health program insight and effectiveness; 2) optimal implementation process and workflows that align primary care with specialists to expand access to care; 3) chronic care management/coordination deployment as an effective extender service to physicians and patients risk stratified based on defined clinical and social determinant criteria; 4) adoption of technology tools for patient outreach and engagement, including a mobile application for remote biometric monitoring and telemedicine; and 5) use of structured communication platforms that enable practitioner engagement and ongoing training regarding the shift from volume to value-based care delivery.
Highlights
National health expenditures are projected to grow at an average annual rate of 5.5 percent for2018–2027 and represent 19.4 percent of gross domestic product in 2027
M-Accountable Care Organizations (ACOs) participant organizations align on a collective mission-critical approach to data aggregation analysis and actionable intent to deliver high quality, equitable and cost efficient care, through community and school-based practice locations within preexisting evidence-based models as well as new care delivery models designed by the M-ACO
By policy design, Aged Non-Dual Eligible Medicare patients do not qualify for Medicaid, and have less complexities based on social determinants. This group comprises less than half of the Aged M-ACO population compared with 80% for the Medicare Shared Savings Program (MSSP) ACOs
Summary
National health expenditures are projected to grow at an average annual rate of 5.5 percent for2018–2027 and represent 19.4 percent of gross domestic product in 2027. National health expenditures are projected to grow at an average annual rate of 5.5 percent for. Effective coordination of health care, social services, public health, and community-based organizations could improve population health outcomes and advance health equity [2,3,4]. Some encouraging innovations are emerging, catalyzed in part by payers, delivery system reform, and the growth of value-based or shared-risk payment models, to support high-value community focused interventions. The Center for Medicare and Medicaid Services (CMS) is testing Accountable Care Organizations (ACOs) and shared savings models as part of its health care innovation program [8,9,10].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
