| |
PFS Consulting
& Services A Division of Provider Funding Services, LLC ACO Non-Clinical Administration ACOs ... A Fundamental Shift in
Organizational Perspective One of the key components of the Patient Protection and Affordable
Care Act is the Accountable Care Organization (“ACO”). At the heart of the ACO business model is the integration
of inpatient, ambulatory, and ancillary care providers. Together they assume accountability for the quality and cost
of health care for defined populations. Led by physicians, ACO organizational realignments and implementation of health
information technology (“HIT”) to support clinical decision making will be critical to their success. Full-risk
ACOs must also focus on the applications needed for capitation distribution, defined population patient/beneficiary administration,
out-of-network payer responsibilities, and risk management. For traditionally structured provider organizations a fundamental
shift in perspectives, attitudes, practices, resources, and information technology will be required. Recognition of Patients as Beneficiaries Successful ACOs
will implement information systems that allow them to recognize and manage information on individuals as beneficiaries rather
than patients. Health plans use membership management systems for this function and ACOs will need to adopt similar systems
and processes to ensure that they can properly identify, monitor and report on all the activity associated with their population
… including no activity. Additionally, ACOs receiving full risk capitation will require the ability
to administer and process claims for health care services delivered by out-of-network providers and to capture in-network
encounter data for use in measuring provider productivity and utilization of services in and out of network. Fail to Plan ... Plan to Fail ACOs will need a strategic plan that includes clinical
and administrative systems and tactics for implementing and integrating them. PFS Consulting & Services
is positioned to provide ACOs with the planning along with the administration of all non-clinical business processes and IT
applications necessary to support administrative reporting requirements. For more than 25 years PFS Consulting
& Services successfully delivered support to Medicaid Managed Care plans across the country which, by definition,
are medical delivery systems that accept full risk capitation for defined populations. ACOs are similar delivery systems
to which PFS Consulting & Services can bring experience, technology, and add value immediately.
|
|
