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Understanding Accountable Care Organizations

On February 17, 2011, Governor Patrick announced legislation that would overhaul the current health care payment system by introducing the concept of Accountable Care Organizations (ACO) and Global Payments to providers.

There are many ways to describe an ACO and many models. The simplest definition is that an ACO is a grouping of providers working together to improve patient care. The goal of the ACO is to increase access to care, improve quality of care and ensure the delivery of care. ACOs are one proposed way to change the payment system by creating incentives to increase clinical integration and care coordination. The concept of global payments is the method that providers in an ACO would be paid. Global Payment is also referred to as "bundled payment” or "lump sum payment”, a move away from the traditional fee for service system that is currently in place. For example, a certain amount of money is assigned to an ACO for each patient to manage the care of that patient. The amount is based on a formula that takes into account diagnoses and past utilization of services over a certain period of time. The risk of cost management shifts from the insurance company to the provider.

The proposed legislation does not spell out the details and it is unclear at this time, if it will reach a clinical social worker as there are few pilot projects that include mental health. However, there is a timeline to have a new payment system in place by 2014.

NASW has been diligently working on this issue over the past few months. The Chapter has consulted with Private Practice SIGs, the HMO/MCO Commission and a small advisory committee composed of NASW members from a variety of practice settings. The Chapter has drafted a set of "Guiding Principles” that were presented to Secretary Bigby. Chapter staff have met with the Secretary and other cabinet and legislative members to present these principles and ensure that the voice of NASW is heard. NASW will continue to monitor the legislation and plans to testify at any upcoming hearings. We will keep members up-to-date with any new information via FOCUS and this website.

 

More on Health Care Payment Reform:

 


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National Association of Social Workers - Massachusetts Chapter
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