Project Management Office, Morehouse Choice ACO-ES, 1046 Ridgeview Avenue, Suite 4, Atlanta, GA 30315, USA.
Department of Medicine, Morehouse School of Medicine, 720 Westview drive SW, Atlanta, GA 30310, USA.
Int J Environ Res Public Health. 2019 Aug 25;16(17):3084. doi: 10.3390/ijerph16173084.
Accountable Care Organizations (ACOs) seek sustainable innovation through the testing of new care delivery methods that promote shared goals among value-based health care collaborators. The Morehouse Choice Accountable Care Organization and Education System (MCACO-ES), or (M-ACO) is a physician led integrated delivery model participating in the Medicare Shared Savings Program (MSSP) offered through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The MSSP establishes incentivized, performance-based payment models for qualifying health care organizations serving traditional Medicare beneficiaries that promote collaborative efficiency models designed to mitigate fragmented and insufficient access to health care, reduce unnecessary cost, and improve clinical outcomes. The M-ACO integration model is administered through participant organizations that include a multi-site community based academic practice, independent physician practices, and federally qualified health center systems (FQHCs). This manuscript aims to present a descriptive and exploratory assessment of health care programs and related innovation methods that validate M-ACO as a reliable simulator to implement, evaluate, and refine M-ACO's integration model to render value-based performance outcomes over time. A part of the research approach also includes early outcomes and lessons learned advancing the framework for ongoing testing of M-ACO's integration model across independently owned, rural, and urban health care locations that predominantly serve low-income, traditional Medicare beneficiaries, (including those who also qualify for Medicaid benefits (also referred to as "dual eligibles"). M-ACO seeks to determine how integration potentially impacts targeted performance results. As a simulator to test value-based innovation and related clinical and business practices, M-ACO uses enterprise-level data and advanced analytics to measure certain areas, including: 1) health program insight and effectiveness; 2) optimal implementation process and workflows that align primary care with specialists to expand access to care; 3) chronic care management/coordination deployment as an effective extender service to physicians and patients risk stratified based on defined clinical and social determinant criteria; 4) adoption of technology tools for patient outreach and engagement, including a mobile application for remote biometric monitoring and telemedicine; and 5) use of structured communication platforms that enable practitioner engagement and ongoing training regarding the shift from volume to value-based care delivery.
责任医疗组织(ACO)通过测试新的护理提供方法来寻求可持续创新,这些方法促进了基于价值的医疗保健合作者之间的共同目标。莫尔豪斯选择责任医疗组织和教育系统(MCACO-ES),或(M-ACO)是一个由医生领导的综合交付模式,参与医疗保险共享储蓄计划(MSSP),该计划是由医疗保险和医疗补助服务中心(CMS)创新中心提供的。MSSP 为符合条件的医疗保健组织提供激励性的、基于绩效的支付模式,这些组织为传统的医疗保险受益人提供服务,促进了旨在缓解医疗保健碎片化和不足、降低不必要成本和改善临床结果的协作效率模式。M-ACO 整合模式通过包括多地点社区学术实践、独立医生实践和联邦合格医疗中心系统(FQHCs)在内的参与组织进行管理。本文旨在对医疗保健计划和相关创新方法进行描述性和探索性评估,以验证 M-ACO 作为一种可靠的模拟器,用于随着时间的推移实施、评估和完善 M-ACO 的整合模式,以产生基于价值的绩效结果。研究方法的一部分还包括早期结果和经验教训,为在独立拥有的农村和城市医疗保健地点(主要为低收入的传统医疗保险受益人提供服务,包括那些也符合医疗补助福利资格的人(也称为“双重资格”))进行的 M-ACO 整合模式的持续测试提供了框架。M-ACO 旨在确定整合如何潜在地影响目标绩效结果。作为测试基于价值的创新和相关临床及商业实践的模拟器,M-ACO 使用企业级数据和高级分析来衡量某些领域,包括:1)健康计划的洞察力和有效性;2)优化实施流程和工作流程,使初级保健与专科医生保持一致,以扩大获得护理的机会;3)基于定义的临床和社会决定因素标准对风险进行分层的慢性护理管理/协调部署作为向医生和患者提供的有效扩展服务;4)采用患者外展和参与的技术工具,包括用于远程生物计量监测和远程医疗的移动应用程序;5)使用结构化的沟通平台,使从业者能够参与并持续培训从基于数量的护理交付向基于价值的护理交付的转变。