As an accountable care organization (ACO), OSF HealthCare is changing the way health care is delivered and payors are changing the way they pay us for the care we deliver.
Health care providers have always lived in a fee-for-service environment; we received a payment each time we provided a service. But payors, both government and commercial, are quickly changing to pay us for the value we provide. This shift from "volume to value" is what it means to be an accountable care organization.
Pay for Performance
Government and commercial payors now base a large part of health care reimbursements on pre-determined quality and safety goals that must be achieved, documented, measured, reported, and improved upon. This is known as "pay for performance" or "shared savings."
If hospitals and health systems improve quality and safety scores and reduce cost, we all benefit from the reduction in cost. A percentage of that cost savings is paid back to these health systems in the form of an additional reimbursement.
Shared Risk Arrangements
Other payors desire a "shared risk" arrangement. In a shared risk arrangement, if quality and safety scores are improved, health systems and payors both share in the savings and receive additional reimbursement. If quality and safety improvement goals are not achieved, they also share in the risk. This results in a reduction in reimbursements from those payors.
Patients of the ACO can also be employees and their families as well.
As the ACO partners with patients to improve their overall health, work place improvements like reduced absenteeism and improved job performance often result.