The Affordable Care Act (ACA) has not only transformed the way healthcare coverage is purchased, but also how healthcare is delivered.
Introduced into Medicare as part of the ACA, accountable care organizations (ACOs) or, in the non- Medicare area, clinically integrated networks (CIN), are a vehicle by which health systems, hospitals and providers accept shared responsibility for the quality, cost and experience of an attributed population in an integrated manner across the continuum.
CMS has tested multiple ACO models over 10 years, which is leading many to evaluate and quantify their efficacy. However, often these analyses exclude the benefits of ACOs outside of savings to Medicare.
For hospitals and health systems, an ACO is a key strategic necessity, particularly with the fiscal pressures on the Medicare Trust Fund catalyzing CMS to move towards finding participants of any willing taker in the fee-for-service (FFS) alternative payment models (such as ACOs) to accept two-sided risk.
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