Schoenbaum Stephen C
The Josiah Macy Jr. Foundation, New York, NY, USA.
Hosp Pract (1995). 2011 Aug;39(3):140-8. doi: 10.3810/hp.2011.08.589.
Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers.
联邦医疗改革已将医疗保险责任医疗组织（ACO）确立为一个新项目，一些州和私人支付方也一直在独立开展ACO试点项目。其目标是让医疗服务提供方对特定人群的医疗质量和成本负责。医疗服务提供方的财务模式通常基于支付方与提供方之间的共享节约机制，或者某种类型的整体支付方式，其中包括部分或全额按人头付费的可能性。为了使ACO以更低的成本实现相同的效果，或者更好的是，以相同或更低的成本改善效果，医疗服务提供系统将需要比目前更加注重初级保健和医疗协调。临床服务提供方为了更有效、高效和协调，将需要各种共享服务的支持，如非工作时间护理、方便获得专科服务以及信息交流。这些服务可以由ACO组织成一个医疗社区或社群。医院由于拥有管理结构、开展项目和服务的历史以及全年无休的可及性，是加强针对人群和其他医疗服务提供方的医疗服务提供的合理领导者。
