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. But 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.
In an accountable care organization, health care providers and patients aren't the only ones who benefit from better care, better quality, and lower health care costs. The benefits for employers go far beyond health care cost savings.
ACO patients are your employees and their family members. As care managers partner with patients and work to better engage them to improve their overall health, this results in an improvement in their performance at work. Reduced absenteeism, improved performance on the job, and an overall greater sense of well-being are positive results that benefit all of us.