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The Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating an ACO and complete the necessary groundwork before CMS's ACO operation date of January 2012.
A valuable guide to starting and running a successful accountable care organization. Health care in America is undergoing great change. Soon, accountable care organizations—health care organizations that tie provider reimbursements to quality metrics and reductions in the cost of care—will be ubiquitous. But how do you set up an ACO? How does an ACO function? And what are the keys to creating a profitable ACO? Pathways to a Successful Accountable Care Organization will help guide you through the complicated process of establishing and running an ACO. Peter A. Gross, MD, who has firsthand experience as the chairman of a successful ACO, breaks down how he did it and describes the pitfalls he discovered along the way. In-depth essays by a group of expert authors touch on • the essential ingredients of a successful ACO • monitoring and submitting Group Practice Reporting Option quality measures • mastering your patients' responses to the Consumer Assessment of Health Plans Survey • how bundled payments and CPC+ can meld with your ACO • how MACRA and MIPS affect your ACO • the role of an ACO/CIN • the complexities of post-acute care • data analytics • engaging and integrating physician practices Dr. Gross and his colleagues are in a perfect position to guide other health care leaders through the ACO process while also providing excellent case studies for policy professionals who are interested in how their work influences health care delivery. Readers will come away with the necessary knowledge to thrive and be rewarded with cost savings. Contributors: Joshua Bennett, Allison Brennan, Glen Champlin, Kris Corwin, Guy D'Andrea, Joseph F. Damore, Mitchel Easton, Andy Edeburn, Seth Edwards, Jennifer Gasperini, Kris Gates, Shawn Griffin, Peter A. Gross, Brent Hardaway, Mark Hiller, Beth Ireton, Thomas Kloos, Jeremy Mathis, Miriam McKisic, Morey Menacker, Denise Patriaco, Elyse Pegler, John Pitsikoulis, Michael Schweitzer, Bryan F. Smith
Is the ACO strategy right for your organization? Accountable Care Organizations will help you understand the ACO framework and assess your readiness to embark on an ACO strategy. This book provides the structural blueprints, management skills, and cultural tools necessary to implement a successful ACO. Practical advice is bolstered with real world examples of leading healthcare providers that are pioneers in the rapidly changing world of accountable care. This guidebook is designed to facilitate critical conversations and decisions at all stages of the ACO development journey. Explore processes and structures and learn how to implement pilots to shape your own ACO delivery model. Each chapter includes takeaway points and tailored action steps for: (1) organizations interested in exploring the ACO concept, (2) organizations taking the first steps towards an ACO model, and (3) organizations already moving full speed ahead. This book will help you answer these questions and more: What does it take to become an ACO? What steps and actions should your organization take to implement an ACO strategy? How can organizational culture support your move to accountable care? How can you build a business plan to support an ACO strategy? What information technology is needed to implement an ACO strategy? How can an merging ACO best negotiate with third-party payers?
Described in the New York Times as “an astonishingly clear ‘user’s manual’ that explains our health care system and the policies that will change it,” The Health Care Handbook, by Drs. Elisabeth Askin and Nathan Moore, offers a practical, neutral, and readable overview of the U.S. health care system in a compact, convenient format. The fully revised third edition provides concise coverage on health care delivery, insurance and economics, policy, and reform—all critical components of the system in which health care professionals work. Written in a conversational and accessible tone, this popular, highly regarded handbook serves as a “one stop shop” for essential facts, systems, concepts, and analysis of the U.S. health care system, providing the tools you need to confidently evaluate current health care policy and controversies.
Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Building on the revolutionary Institute of Medicine reports To Err is Human and Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working conditions and demands. Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system. During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk. This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.
A practical guide to bringing accountability into the workplace and into the daily life of managers and staff. This book provides a working guide, through specific examples, of what accountability is; how to instill it within your company; and how to measure and quantify its effectiveness. Accountability has become significantly more important as corporate scandals have rocked the country. Here is the one book to have to bring positive change to your workplace and daily life.