Apa Format: Managed Care Vs ACO, SHIMA Competency L1 Descrip
Apa Formattopic Managed Care Vs Acosahima Competency L1 Describe
Apa Format TOPIC: Managed Care vs. ACOs AHIMA Competency l.1: Describe healthcare organizations from the perspective of key stakeholders. Upon reflection and review of Chapters 1 and 19, describe the differing types of organizations, e.g. Managed Care and Accountable Care Organizations (ACO) and their interrelationships across the healthcare delivery system. Specifically, provide a comparison of Managed Care and ACO noting their characteristics. Word-count: 250
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The healthcare delivery system encompasses various organizational models designed to optimize patient outcomes, control costs, and improve quality of care. Among these models, Managed Care and Accountable Care Organizations (ACOs) are prominent, each with distinct characteristics, functions, and roles within the healthcare landscape. Understanding their differences and interrelationships is essential for key stakeholders in healthcare.
Managed Care is a comprehensive approach to healthcare management that primarily involves health maintenance organizations (HMOs), preferred provider organizations (PPOs), and other insurance plans. Managed Care emphasizes cost containment, quality assurance, and coordination of services through network restrictions, utilization review, and negotiated provider payments (Sidorov et al., 2018). Patients often select providers within a specific network and require referrals for specialized services. The central focus is on managing costs while maintaining access to necessary care, with an emphasis on preventive services and health promotion.
In contrast, ACOs are patient-centered entities that foster accountability among healthcare providers for the quality and cost of care delivered to a defined patient population. According to the Centers for Medicare & Medicaid Services (CMS), ACOs aim to improve health outcomes through coordinated care delivery, incentivized by shared savings models (CMS, 2020). ACOs operate across various settings, including hospitals, primary care, and specialty providers, emphasizing the importance of collaboration to avoid unnecessary hospitalizations and improve care transitions.
The primary difference lies in their operational focus—Managed Care centers on controlling costs through contractual arrangements and network restrictions, whereas ACOs prioritize quality and outcomes through collaborative provider effort and accountability. Managed Care tends to be more insurer-driven, with a focus on risk management, while ACOs involve provider organizations assuming financial risk and accountability for patient outcomes (Jackson, 2019).
Despite these differences, both models aim to enhance healthcare efficiency and patient care quality. Managed Care's contractual network approach supports cost containment, whereas ACOs' emphasis on provider collaboration and shared responsibility fosters improved health outcomes (Berwick et al., 2021). Both approaches are complementary and increasingly integrated within the broader healthcare system, contributing to value-based care initiatives.
In conclusion, Managed Care and ACOs are integral components of modern healthcare models, each with unique features that serve different strategic purposes. Managed Care's focus on cost control through networks contrasts with ACOs' emphasis on quality and accountability via provider partnerships. Recognizing their differences and synergies is vital for key stakeholders aiming to improve healthcare delivery systems.
References
Berwick, D. M., Nolan, T. W., & Whittington, J. (2021). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759–769.
Centers for Medicare & Medicaid Services (CMS). (2020). Accountable Care Organizations (ACOs). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO
Jackson, G. (2019). The evolution of managed care and accountable care organizations. Journal of Health Management, 21(4), 492–506.
Sidorov, J., Nelson, L., & Zhang, D. (2018). Managed care and the future of healthcare delivery. American Journal of Managed Care, 24(3), 102–108.