An acronym for “Accountable Care Organization”, an ACO is a model of healthcare delivery in which a group of healthcare providers agree to accept payment for their services based on the aggregated health outcomes of the patients they see, as opposed to the total number of services performed. ACOs reward providers in a “fee for health” model, as opposed to a traditional “fee for service” model. Although the term ACO can apply to a variety of types of organizations, regulations for establishing ACOs to participate in the Medicare Shared Savings Program specifically were included in the Patient Protection and Affordable Care Act of 2010.
(August 25, 2010 – Source: Kevork Djansezian/Getty Images North America)
At a press conference last Thursday, Secretary of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder announced the creation of a “Public-Private Partnership” to prevent healthcare fraud. The voluntary partnership between federal and state agencies, private healthcare insurers and fraud prevention groups is designed to share information among all groups proactively to go after common healthcare fraud schemes. Sharing information like best practices, front line observations on emerging threats as well as “scrubbed” patient population data will allow coordinated efforts between payers and law enforcement to stop fraud before it happens.
“Previously, neither the government nor insurers chased the money until it was ‘out the door’ in what has been called a pay-and-chase model. Now, we’re taking away crooks’ head start” – Secretary of Health and Human Services Kathleen Sebelius
Building on new legislative tools passed as part of the Affordable Care Act, as well as initiatives like the Healthcare Fraud Prevention and Enforcement Action Team (or HEAT for short), the new public-private partnership is designed to share intelligence with all stakeholders in fraud prevention so more fraud can be prevented as opposed to prosecuted.
For fraudulent providers and billers, the effects of the new partnership should be pretty obvious – more and better ways for you to get caught. But for the the compliant majority, data sharing partnerships like this one provide insight into how payers law enforcement will be working together in the future. As more health data is standardized, easily blinded and shareable, information partnerships between all parts of the healthcare ecosystem will become more common, and software vendors will find more ways to slice and dice the “big data” to detect fraudulent billing.
As managers, providers and employees, we always have to be looking ahead at how the technology on our horizon will affect how our organizations administer health care. In the spirit of looking forward to the future, we present “2.0 Tuesday”, a feature on Manage My Practice about how technology is impacting our practices, and our patient and population outcomes.
We hope you enjoy looking ahead with us, and share your ideas, reactions and comments below!
HealthCamp RDU and Health Innovation Week DC Bring Stakeholders Together for Conversations on the Future of Healthcare
Over the next two weeks two separate events will give stakeholders from all ends of the healthcare spectrum a chance to be a part of an open-ended conversation about the future of care. HealthCamp RDU on Wednesday May 23rd in Raleigh, North Carolina, and Health Innovation Week, beginning June 2nd in Washington D.C. will be fantastic gatherings for providers, patients, advocates, managers, and vendors to come together, engage in conversation, and share their own experiences and visions for the future. With the large-scale changes taking place in healthcare today, more than ever it is critical to share your point of view, and events that bring together such a wide range of attendees offer fantastic opportunities to do just that. Check out their sites for more information on these great events!
