Accountable Care Organisation Risk Management Plan (Other (Not Listed) Sample)

Accountable Care Organization (ACO) Risk Management Strategic Plan
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Introduction
This Accountable Care Organization (ACO) Risk Management Strategic Plan is developed to ensure both hospital and physicians are in alignment with necessary cost and quality of care objectives so that they can manage in providing the target community with effective health care at low cost. This plan demonstrates how to overcome the risks involved in organizing physicians into partnerships with the hospital to improve care, cut costs and be held accountable for results.
The ACO Standards and Objectives for Medical Facilities and Physicians
1 Understanding the Organization Model
The ACO will operate as a level organization with a governance rooted in formal arrangements such as contracts between members and the ACO. The ACO integrates a hospital and a large group of employed physicians. This makes the ACO an Integrated Delivery System model. The ACO under this model will have to strive and redesign the delivery of health care in achieving the greater value in both quality of outcomes and reduce total costs. The physicians and all the involved facilities will have to blend to align the capitation payments, apply evidence-based medicine and share patient information.
2 Roles of Individual Providers in the Model
All providers will work effectively together as a system in providing appropriate and coordinated care for ACO the ACO patients. The different providers will play various roles that will directly provide services to the patients and also the ACO governance and operation. Not all ACO members including contracted providers and employed will participate in shared savings (or loss).
The specific configuration for an ACO will be expected to vary depending on patient needs, the local practice environment and the infrastructure that will be required to support the providers for services such as finance, analysis, IT, and performance improvements.
Patients will be assigned to providers. Primary care will be relied on as a foundation of providing improved care at a lower cost. Evaluation and measurement services that primary care providers provide will be the preferred basis of assigning patients to ACOs.
3 Proper Governance
The ACO will have to identify right leaders. Good leadership will ensure success of the ACO. The ACO will require capable clinical, strong, fiscal and administrative operations leaders. Candidates will come from provider participants or existing health system. The ACO may also recruit outside candidates alternatively as leaders, or outsourcing service to vendors with proven capability to implement functions.
The ACO will have two main functions that it will have to play. First is the management that include oversight within ACO for all strategic and high-level operation matters. Second is clinical roles that have an overall clinical role of ensuring that the ACO provides the most economical setting for an ACO patient.
4 Local Accountability
The ACO will aim at being accountable to its patients and the whole community it serves. It will always strive to improve patient health and overall care reducing costs for the patient and the community. This will require the ACO to provide meaningful evidence of its cost and quality effects. The ACO will bring together all the participating providers and assign them patients, then the ACO will come up with a budget. The budget will provide the actual and the projected benchmark cost which will allow the ACO to monitor costs and identify potential inefficiencies.
5 Sharing the Savings
The ACO will offer achievable opportunities that are realistic for providers to share in the savings that will be made from delivering higher value care. The incentive system will reward providers for delivering efficient care and not the volume driven system. All the providers will be compensated on the quality of service they will offer to the patients. The ACO will already have a payment plan where the physicians will still be paid through their original payment plans but now through the ACO from the capitation payment.
Plan to Communicate and Educate ACO Providers, Facilities and Staff
Providers, facilities, and all staff need to know of what is expected of them as plans to set up an ACO are put in place. A proper communication mechanism needs to be in place to relay the information to them. The providers as well need to be educated about the whole process and procedure of the ACO in details. A communication network will still have to be put in place that will ensure patient information is able to flow from one department to the other. This will ensure delivery of the best medical care to the patients. . The following is the mechanism to be used in relaying the information to providers and all facilities participating regarding this risk management strategic plan.
1 Mobile Phones
We are living in the world when almost everybody has a mobile phone. Having personal numbers of all providers is necessary for reaching them. However, mobile phones are not good for passing a lot of information to a large group of people. They can be used for notifying them on meetings or seminars.
2 E-mails
E-mails are a more formal way of passing information and communicating. Each member of the participating group should be able to have a mail he or she can be reached on whenever important information is relayed. E-mails are also quick just like the phone, but mails can carry more data including graphs and pictures. This would present information in an educative manner.
3 Conferences and Seminars
As the phone and mails may be used to pass urgent information, plans of having conferences and seminars should be put in place. During the seminars and conferences is when proper educating and learning about the standards and objectives is done. This should happen timely enough enable the providers to be physically and psychologically prepared in good time for the change.
4 Flyers
For the providers to remain knowledgeable of the objectives and standards of the ACO, the strategy would have to be given to each in a copy so that they are able to reflect on them and always be aware of what is expected of them.
Dashboard Benchmarks in the ACO Health System
1 Cost and Utilization
The ACO comes up with a budget after all the providers have come on board and the number of patients to be served established. The budget becomes a necessary and important tool in ensuring that the ACO is running on a cost effective program. Over the years of operation, the cost performance is supposed to lower as per the annual spending and utilization while the outpatient care will be expected to increase.
2 Patient Experience
This is measured by patient satisfaction with hospitals health plans and physicians. The ACO assumes greater accountability for a patient’s health, improves on care coordination, increases transparency which leads to more satisfaction in patients.
3 Population Health
It is a key factor for the ACO to be effective. Preventive measures like vaccinations, smoking cessation, and cancer screening should keep being put in place. Patients with chronic diseases are also kept healthier
Evaluating Benchmarks for the ACO.
The following are the areas that should be evaluated to e...