Medical care has historically focused on treating the disease, and not the patient. A disjointed system of physicians and hospitals, insurance companies and government payers has resulted in inefficient care delivery and payment models, which has restricted patients’ ability to receive integrated, coordinated healthcare. Recently, a renewed focus on patient health and safety has led payers and providers to begin working together to improve healthcare affordability, access and quality. Accountable Care Organizations (ACOs) and health homes/patient-centered medical homes are two healthcare delivery models that expect to help payers and providers deliver more integrated, cost-efficient and higher quality patient care.
Accountable Care Organizations
The Centers for Medicare and Medicaid Services (CMS) defines an ACO as “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care” of its members. Although ACO structures may vary, ACOs will need to demonstrate five critical competencies, including the ability to:
- Design, organize and manage an efficient and effective clinical delivery system;
- Integrate care across time, settings, disciplines, providers and geographies;
- Innovatively price care delivery;
- Rationally distribute premium and potential savings dollars, and
- Operate simultaneously in two potentially contradictory models for a period of time.
Health Homes and Patient-Centered Medical Homes
Similarly, health homes and patient-centered medical homes seek to provide an integrated, coordinated approach to healthcare delivery that treats the person and not the disease. Having a single entity responsible for coordinating all of the healthcare and ancillary services that a person receives may result in improved health outcomes, higher patient satisfaction and lower healthcare costs. The core principles of health homes and medical homes include:
- Personal Physician
- Physician Directed Medical Practice
- Whole Person Orientation
- Coordination and Integration of Care
- Quality and Safety
- Enhanced Access
- Appropriate Payment
Proven Track Record
The planning, implementation and ongoing operations of ACOs, health homes and medical homes requires a unique combination of provider, payer and clinical expertise. The depth of our health care team’s expertise includes working for and with physician groups, hospitals and health insurance plans, clinical operations and healthcare program design, implementation and evaluation.
We assist health systems with the design, development and implementation of ACOs nationwide, including work with several payers, large health systems and physician practices.
Navigant’s healthcare practice is a nationwide network of nearly 500 dedicated consultants with proven experience working with providers, managed care organizations and State and Federal agencies to assess and implement ACOs, health home and patient-centered medical home initiatives.
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