RUPRI Center for Rural Health Policy Analysis, University of Iowa, Iowa City, Iowa, USA.
J Rural Health. 2011 Winter;27(1):131-7. doi: 10.1111/j.1748-0361.2010.00350.x. Epub 2010 Dec 3.
This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs).
ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under Medicare. This article explores ACA implications, using the literature to describe successful integrated health care organizations that will likely become the first ACOs. Previous research studying rural managed care organizations found rural success stories that can inform the ACO discussion.
Preconditions for success as ACOs include enrolling a minimum number of patients to manage financial risk and implementing medical care policies and programs to improve quality. Rural managed care organizations succeeded because of care management experience, nonprofit status, and strong local leadership focused on improving the health of the population served.
Rural provider participation in ACOs will require collaboration among rural providers and with larger, often urban, health care systems. Rural providers should strengthen their negotiation capacities by developing rural provider networks, understanding large health system motivations, and adopting best practices in clinical management. Rural communities should generate programs that motivate their populations to achieve and maintain optimum health status. Policy makers should develop rural-relevant ACO-performance measures and provide necessary technical assistance to rural providers and organizations.
本文为农村医疗服务提供者、社区和政策制定者描述了一项支持或建立问责制医疗组织（ACO）的策略。
ACO 代表了一种新的医疗服务提供和提供者支付系统，旨在提高临床质量并控制成本。《患者保护与平价医疗法案》（ACA）使 ACO 合同成为医疗保险的永久选择。本文通过使用文献来描述可能成为首批 ACO 的成功整合医疗保健组织，探讨了 ACA 的影响。先前研究农村管理式医疗组织的研究发现了农村成功案例，这些案例可以为 ACO 讨论提供信息。
作为 ACO 成功的前提条件包括招募足够数量的患者来管理财务风险，并实施医疗保健政策和计划以提高质量。农村管理式医疗组织之所以取得成功，是因为它们具有护理管理经验、非营利地位以及专注于改善服务人群健康的强大地方领导力。
农村提供者参与 ACO 将需要农村提供者之间以及与更大、通常是城市的医疗保健系统之间的合作。农村提供者应通过发展农村提供者网络、了解大型医疗系统的动机以及采用临床管理的最佳实践来增强其谈判能力。农村社区应制定激励其人群实现和保持最佳健康状态的计划。政策制定者应制定与农村相关的 ACO 绩效衡量标准，并向农村提供者和组织提供必要的技术援助。
