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DDHA 8450- WEEK 11 Final Project Template Evaluation Plan for Accountable Care Organization (ACO) Formation 1

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DDHA 8450- WEEK 11 Final Project Template Evaluation Plan for Accountable Care Organization (ACO) Formation 1. Project objectives 2. Evaluation questions 3. Evaluation methods a. Data b. Measures 4. Timeline a. Implementation timeline b. Evaluation timeline © 2016 Laureate Education, Inc. Page 1 of 3 DDHA 8450- WEEK 11 INSTRUCTIONS FOR THE FINAL PROJECT Final Project: Evaluation Plan for Accountable Care Organization Formation Consider the following scenario: You are a health care administrator for a large community hospital in an urban market. Your hospital has already made substantial investments in health information technology and physician participation. In response to health care reform, several competing hospitals are starting to form ACOs to participate in new payment models designed to reduce costs and improve population health. The board of directors for your hospital has requested that you lead the development of an evaluation plan to assess the potential impact of ACO formation. In particular, the board wants to understand how the ACO will align with the organization’s strategy and what information will be required to assess the impact of the ACO on your organization’s performance. For this Assignment, reflect on the scenario presented, and consider how you might implement an evaluation plan for the desired outcomes and goals described. Consider what steps you might take as a current or future health care administrator and how an evaluation plan should be developed for a project such as that described in the scenario. © 2016 Laureate Education, Inc. Page 2 of 3 DDHA 8450- WEEK 11 The Assignment (15–20 pages): • Describe the measures and methods you would use for the evaluation plan, and explain why you would use them. Be sure to include what type of data you need to collect and a definition of the metrics you would use. • Propose and develop a timeline for the implementation and evaluation plan for the scenario described. Be sure to highlight any challenges or opportunities in regard to adhering to the proposed timeline you develop. Suggest additional strategies you might recommend to ensure the implementation and evaluation plans are completed on time. Be specific and provide examples. • Explain how the evaluation plan contributes to the feedback loop for effective management of an ACO. • Explain how you will ensure that the evaluation plan you propose is aligned strategically with the mission of the ACO and why. Required Readings & RESOURCES TO BE USED Longest, B. B., Jr., & Darr, K. J. (2014). Managing health services organizations and systems (6th ed.). Baltimore, MD: Health Professions Press. Chapter 9, “Strategizing” (pp. 454–455) Chassin, M. R., & Loeb, J. M. (2013). High?reliability health care: Getting there from here. The Milbank Quarterly, 91(3), 459-490. Clark, J., Singer, S., Kane, N., & Valentine, M. (2013). From striving to thriving: Systems thinking, strategy, and the performance of safety net hospitals. Health Care Management Review, 38(3), 211-223. Nolan, T. W. (2007). Execution of strategic improvement initiatives to produce systemlevel results [White paper]. Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/resources/Pages/IHIWhitePapers/ExecutionofStrategicImprovementIn itiativesWhitePaper.aspx Document: Final Project Template (Word document) Porter, M. E., & Lee, T. H. (2013). The strategy that will fix health care. Harvard Business Review, 91(10), 50-70 © 2016 Laureate Education, Inc. Page 3 of 3 HEALTH Health Evaluation Plan Your Name Your University Course Name and Number Professor Name 9th May 2021 (Total Words: 4072) HEALTH Evaluation Plan for Accountable Care Organizations Introduction Over the past few years, the healthcare system has been undergoing a few formal strategies to help it achieve more success. These strategies are aimed at helping the sector to be able to deliver effective health services and also reduce the health cost that comes as one undergoes medical assistance in the country. This aided in the formation of Accountable Care Organizations, better healthcare payment methods, and the delivery methods of the health care services in question. Moreover, delivery methods have been developed worldwide, and these platforms aim to make the health care system convenient and accessible. An excellent example of the progress being achieved; most of the contracts that are being made today are coming from the health organizations that are being established and the health caregivers. Thus, it makes the work achievable and straightforward as the government can now achieve more as it only has to sign the agreed terms and facilitate the processes where necessary. It makes the costs low, and the health care services become achievable and convenient for so many people. Therefore, it would be very accurate to say that the job being achieved in the health care sector is good, and the progress is growing slowly by slowly. (Briggs et al.,2019) It would be true to say that the health sector has been under attack over the few years, as the community may have noticed. This is because hospitals have not had the proper guidelines and means to handle most of the issues that arise from the health sector. This is because there has not been steps and means that have been put into place to make sure that hospitals have adequately dealt with these issues. For example, health care has been so expensive over the past few years. This is because care providers did not have the proper means to make sure these payments were looked at and dealt with. However, with the introduction of ACOs, this sector is set to improve. HEALTH The below essay aims to show precisely how this will happen because the payments are set to decrease, the health performance is set to increase, the money allocation is set to improve, and so many other benefits. So, without any further a due, let me take you down to the importance of the ACOs. Definition of Terms The overarching aim of the Affordable Care Act (ACA) is to provide affordability for the healthcare system's beneficiaries. Incentivizing physicians, hospitals, and service professionals to coordinate scientifically optimal patient care is one of the primary reasons it achieves valuebased outcomes. When clinical treatment is provided successfully and with high-quality results, healthcare providers obtain various (financial and other occupationally based) benefits. Strategies including the Bundled Payment Care Initiative (acronym BPCI) or Affordable Care Organizations (ACOs) will reduce costly and redundant programs to make them more costeffective for consumers. (Gordon et al.,2018) Exceptional quality standards must be met by hospitals and doctors, emphasizing disease control, carefully treating patients with chronic illnesses, and keeping patients safe. Policymakers experts created the name ACO to describe entities made up of professionally integrated healthcare professionals. Healthcare works together for a common clinical objective and outcome; effective, high-quality patient care, using a standard clinical pathway that incorporates treatment principles and treatment options in a multi-faceted provider setting. There are three central values of Affordable Care Organizations: • Provider-led companies with a solid primary care foundation that are held responsible for outcomes and per capita costs HEALTH • Payments are related to quality management and cost reduction. • Reliable and highly advanced success assessment promotes progress and gives assurance that treatment strengthens and cost-savings prevail. To meet these objectives, the ACA dramatically altered the way healthcare is delivered and providers' compensation. Although the primary goal of the Affordable Care Act is to offer affordable health benefits to all Americans, different components have a significant effect on how doctors are reimbursed for delivering care. A series of managed care schemes are gradually replacing the conventional fee-for-service structure. The Affordable Care Act proposes to further overhaul the healthcare delivery system by establishing Accountable Care Organizations and the Bundled Care Payment Initiative. (Hu et al.,2018) Affordable Care Organizations position financial responsibility on physicians to strengthen patient control and reduce unnecessary costs while allowing consumers to choose medical providers. The ACP framework encourages health excellence by controlling costs. This cost-cutting relies on the ACA's ability to incentivize hospitals, doctors, post-acute care clinics, and other providers to create alliances and facilitate improved care management. Affordable Insurance Organizations hope to minimize the need for minor medical care and enhance patient outcomes by increasing treatment management. Project Objective. As stated above, the health sector has been demined for a very long time. The creation of ACOs has been on the line for quite some time. This is because the government has been trying to make sure that it has improved this sector and make permanent changes that will need amendment in the future. HEALTH The establishment of Accountable Care Organizations in the health sector is because they want to improve how the health sector is managed and run. They tried to delocalize the health sector and ensure every citizen can be given health care at a reduced cost and get it very well. The project aims to; • Deliver vital health care services. • Provide top health care services. • Improve the systems in which health care offers services to patients. • Lower the cost of health services • Improve the convenience of patients • Also aimed at improving the preventive measures of diseases, i.e., malaria • Reduce the risk level of most of the population. • Put in measures that facilitate operations of ACO's. • They wanted the ability to start projects and monitor and complete them. • They also wanted permanent strategies that would ensure the health sector is improved once and for all. It had come to the attention of the health sector that it had been stagnant for quite some time now and that it was not growing. Therefore, it embarked on the creation of ACO's. These ACO's purpose aims to improve the health sector and make sure it went back to the glory that it was meant to have. So, apart from the obvious stated benefits above, the following was also meant to be achieved: HEALTH - The government was meant to restore its health sector to the glory it had. For so long, the health sector had been let down. These ACO's were to act as a way to give the government relief. - The health sector had been in the hands of the government for quite some time now, and the government wanted to delocalize these duties and share this responsibility with the larger community. - Also, purchasing health equipment would be very expensive for the government to afford. So, the formulation of ACO's was also a way to reduce this cost. They would achieve this because they must have several equipment to qualify for a health center to be selected. When they purchase this equipment, then the government reduces cost. - Minimize corruption in the health sector. For a long time, the health sector had been in the hands of the government and so had become prone to manipulation by the government officials. Therefore, when the government formulated the ACO's, it destroyed these manipulation elements because it was no longer in the hands of the government. (Jain,2016) - Lastly, the government wanted to win the people's trust again. This is because it had let them down so many times when it came to the health sector, and so it wanted to make sure that it showed the people that it indeed was working towards making this a better place for them. Evaluation Methods. As it is known, with new changes comes a lot of responsibilities. With that said, so many health organizations would come forward and make pledges to improve the health sector. Thus, steps and regulations had to be put in place to ensure that the organizations selected were not just HEALTH any organizations but also organizations that would help change the health sector. (Jakovljevic, Ogura,2016) Therefore, what brought several evaluation criteria to the table would help make sure that the selection was good enough. Some of those evaluation questions were; - What were the goals and achievements that the ACO aimed to achieve? - What are the main benefits of the ACO's? - How will health care improve with the implementation of the ACO's? - How will these ACO's even operate? - What are the measures and requirements being looked at for an ACO to qualify? - Who will monitor these ACO's? - How will the already established measures be amended? - What measure will be put to know if an ACO works as required? Most of these evaluations seem tight because we aim to make sure that the management team establishes organizations that will improve the health sector and take it to the next level without having to come back to them for errors. The benefits have to be evaluated and compared to the risk of putting the health sector and assessing whether the risks outweigh the benefits. When it comes to change, a lot has to be put into consideration. This is because many people oppose the changes that are right around the corner, waiting for someone to mess up and throw in the blames. That is why the evaluation methods have to be accurate and make sure that they have carefully analyzed every possible loophole that may arise from the same. For example, people had gotten used to going to government hospitals for medical care because they believed HEALTH that it was the best service they would ever receive. With the introduction of ACO's, the same had to be met and put into consideration. The government's health sector has to look at the methods closely used to come up with these ACO's or else they will lose the confidence of the people if something does not go as planned. (Jakovljevic, Pejcic, 2017) Data evaluation. For anyone to consider changing anything around them, they must have a good reason for doing so. Thus, it may be because it noticed the processes they are using are not helpful and need adjustments, or they need to be changed to achieve the original goal. In this case, it would be true to say both reasons are applicable. I'm saying this is because some of the existing strategies have to be changed totally. For example, there was no ACO in the past. That is to say that people had to go to the government institutions, and that meant that there were long queues, and most people ended up not receiving the care they needed. Not to mention the fact that most of the time, it was not as affordable as most people would have preferred it. However, all these changed with the establishment of ACO's. It is seen in the current statistics taken that shows; the admission rate in the facilities has reduced by 6.3% because the health care services were delocalized and could be done at the nearest ACO's. Also, the lengthy stays at the hospitals have reduced as the ACO's provide the best health care one would need; thus, releasing of patients is faster. This data was taken because it was required to see if the systems that were being set were helpful to the government or just for paper. But from the data evaluation that has been done, it would be accurate to say that they are working just perfectly. (Kino, Kawachi,2018) HEALTH It will not be enough evaluation if one does not consider if the ACO has any monetary aid to the government. Over five years since who set up the ACO's, the government has saved up to a minimum of $26.6 million. It is estimated that it would save a further $800 million if only the established requirements are achieved. Its success, however, would depend on the fact that the established guidelines are followed to the letter and the progress monitored at a close range. It would include the collaboration of the government, the ACO's, the health worker, and the health system in general. In general terms, the evaluation process is one of the most critical elements of the whole process. This is because most of the data is collected will tell whether the changes made to the system are good enough or are just going to make the whole system worse. For example, the already existing system had data of its own that may be known to the public and have already gotten used. So, if the government's health sector decides to formulate these ACO's, it must be able to compare the data collected and that which already exists and show the difference. Then, they will have shown the benefits and thus propelled the changes to the next level. However, if the data they collect shows a negative change or no change at all, then the same health sector must go back to the drawing table and develop better ways to improve the health sector in question, especially the ACO's. (Kino, Kawachi,2018) Evaluation Measures. The evaluation measures mean the execution of the processes that have been put in place. These processes have to be executed and met for the regulations in place to work. Some of how who can perform these processes include; HEALTH - They are expanding the health care system. It is known that when a sector of the economy looks like a monopoly, it can be manipulated by a few individuals, making it prone to mismanagement. But if an industry is delocalized, then the services are affordable because the benefits are almost everywhere. - It aims to be achieved with the changes in the health sector with the introduction of ACO's. They will be able to distribute the health services, thus reducing monopolization. - There will also be a need to increase the building of teamwork. As the measures are being made, they must ensure they have encouraged partnership between the necessary sectors to ensure that none of them feels left out of the whole deal. - It would ensure that all parties make the efforts. - In creating these measures, it's essential that the well-being of the patients. They are the primary recipients of these services, so any set standards should be on their side. - The ACO's chosen must have the necessary facilities to give good health care. It is a significant measure because if this is not considered, then the fundamental change will not be worth the process. (Kino, Kawachi,2018) - Access to these facilities should also be considered. It means that the ACO's being selected must be evenly distributed to ensure that the services are accessible from any part of the country. Otherwise, it would not make sense to choose ACO's in one area. - There should also be measures that consider the pricing. The discussion's whole point is to make sure that the recipients can afford the services. It would mean that the ACO's being selected must sit down and come up with prizing that aids the recipients. - The healthcare services must also be accessible 24 hours a day, seven days a week, and 52 weeks a year if I put it in a more straightforward manner, 24/7. It is because the HEALTH government hospital offers 24/7 services. Therefore, any measure that is being put in place must include this clause. - The strategies being laid must also include an increase in the primary services provided by the ACO's. This organization must provide essential services to make sure that the whole regions get the same thing. THUS, most ACO's provide different services, thus may not promote equality, and who may not meet the entire point of the delocalization. These services may include eye care services, diagnosis, and treatment of acute illnesses, inpatient and outpatient services, etc. - There must also be accessibility to professions as all these are being laid down. It is to means that every ACO must be able to show the occupations that it can offer. When there is a discussion about an effective health care system, there must be people who can provide these health services. If this is not available, then anything discussed will not yield fruits. - There must also be people who will monitor these ACO's. Most organizations tend to slow down their services once they receive the selection. Therefore, a body will ensure these organizations are always providing these services and providing them to their very best. (Kino, Kawachi,2018) - It is known that medical staff is essential for providing medical services. Therefore, there must be a strategy that is set will be responsible for hiring medical staff and also making sure that they work as a team. It means that no matter which ACO you are working for, they will always have unity to ensure these services are provided. Also, trust and respect must be encouraged between the health workers. HEALTH - Wellness must also be encouraged. Wellness means that who must access the patient's condition at all levels. It is because most of the illnesses that are in society are a result of unwellness. For example, if a patient is under stress, that means that most of the time, they will lack appetite, feel dizzy, and so forth. If symptoms of an illness are not found, then who must test these measures to ensure the health care given is enough and complete. It will also help the government measure the wellness of its citizens. - There should also be a collection of the data collected by these ACO's. The collection of these data is very beneficial to the health sector in many ways. For example; - The government will be able to make an adequate health budget and enough. - The government will assess its growth and know if there's any improvement in this sector. (Kino, Kawachi,2018) - It also knows which areas need to be improved and what needs to be done. - Plans for the most terminal diseases have to be discussed. Some conditions have become a pest in the health sector, and most of them prove challenging to deal with them. So, these ACO's that are being formed must give away in which they will handle these situations and if they can contain the spread and offer the necessary services such as therapy and so forth. - The growth of these ACO's is also something that should measure. It means that a period should be put in which these ACO's will be accessed and note which ones are providing the best care and if some organizations have developed and needed to be included in this program and which ones need to be disqualified. (Kino, Kawachi,2018) HEALTH - I would also add an assessment period of the whole program in general. It should be accessed after a given period and considered it's helpful to the government. If not, that should look for a new strategy. (Kino, Kawachi,2018) - When on the same point, it would also be essential to get an external council to help the evaluation of the changes made. This is because countries have significant health sectors and have grown to be giants when it comes to the same. It would be very naïve and reckless to start this process without having a nation that would back us up if the community needed help. - On the same note, it would be essential to have foreign doctors as a measure. This would apply to the extreme measures where the medical kinds of staff need outside assistance— for example, professional neurosurgeons, professional cancer therapists, and so forth. - Finally, the financial implications have to be considered. This is because any change that comes at a cost before it's adjusted. Therefore, the financial measures have to be laid down to note if the government can facilitate the same or not. Theoretical approach. The above measures need to be evaluated to make sure they make sense. This program has some set targets that it needs to achieve and accomplish. These targets cannot just be achieved easily, and so, there has to be an approach to establish if it will take at all work. To achieve this, there is a need to use Fisher's Logic Model. This model aims to elaborate the measures put, their implementation, and their operations. The model in question seeks to make sure it analyzes the factors put in front of it and assesses their credibility. If there are any changes to be made, the model can detect them. (Moy et al.,2021) HEALTH Therefore, this process is fundamental to this project because it will be worth the entire process if the model qualifies the project. But if it's not able to validate the efficiency of the whole thing, then the health sector will be forced to go back to the drawing table and make the needed changes. Moreover, the theoretical approach is also aimed at showing us the reality of the whole project. What do I mean by this? It is noted and seen the benefits that the project will bring to the health sector. But that's only on paper and not actualized. The theoretical approach tends to get everything that was discussed into reality and shows us whether the measures and guidelines that were formulated are accurate and whether they can be achieved or not. Once this approach is made, the ACO's will either be given the go-ahead or return to the table, and everything recalculated again. Importance and Benefits. The health sector's process is very beneficial to all the parties involved. Some of these benefits include; - The government will be able to make the budget easily as per the health sector. It is because it will have all the requirements, thus knowing how much to use. - It will also delocalize the health sector, and thus it will not be able manipulated by any individual, thus making it easy to manage. - It will be cost-effective to the patients and, therefore, pay and get the best services simultaneously. - Due to the establishment of ACO's, the health services have been delocalized, which means they are easily accessible. HEALTH - It also creates harmony in the health sector. The ACO's will have to work together to provide necessary services, thus making the health sector effective. - It would also offer a solution to terminally ill patients because they will have centers where they can be treated instead of going to government health centers. - There will also be the provision of high-quality services. - It would also be accurate to say the health sector will not have been put in the public's hands. Before this delocalization, all the services were offered by the leading hospitals of the government, and no one would question them. However, with the introduction of this system, the public will report any ACO's that does not do their job correctly to the relevant authorities. - Generally, there will be an improvement in the health services offered. (Moy et al.,2021) Challenges to ACO's program. It would be very naïve of us not to admit that this process must also face a few obstacles. It is because no change comes without difficulties of its own. Some of these challenges include; Assessment of which ACO's to take will be challenging. It is because so many organizations are available, so the selection criteria have to be problematic. The implementation of the terms agreed is also not easy, and so it may take some time to actualize. There must also be a period of implementation that will have to be created, and that could prove to be hectic because the government may not have complete control of the factors that affect this. i.e., the acquisition of necessary equipment by selected ACO's. Conclusion HEALTH Change is often very delicate. This is almost all the scenarios that it occurs. This is because change can either be positive or negative. But in both cases, the outcome of the result is often controlled by the powers involved from the word go. The changes that are being implemented in the health sector are outstanding and could have a burdensome impact on how the health sector proceeds. However, the identical swords that make it suitable might also be the same that harms the health sector. So, the regulations that are being put will have to be followed to the letter, and they will have to be performed with at most diligence. If this is not done, the damage that will be incurred will be much worse. The changes being talked about are very beneficial to all the stakeholders involved. It is because it modernizes the health sector and makes it very helpful. It's a very innovative program, and if the government can actualize it, it will be very beneficial. HEALTH References Briggs ADM, Fraze TK, Glick AL, Beidler LB, Shortell SM, Fisher ES. (2019) How Do Accountable Care Organizations Deliver Preventive Care Services? A Mixed-Methods Study. J Gen Intern Med. 2019 Nov;34(11):2451-2459. doi: 10.1007/s11606-019-052715. Epub 2019 Aug 20. PMID: 31432439; PMCID: PMC6848496. Gordon, S. H., Gadbois, E. A., Shield, R. R., Vivier, P. M., Ndumele, C. D., & Trivedi, A. N. (2018). Qualitative perspectives of primary care providers who treat Medicaid managed care patients. BMC health services research, 18(1), 728. https://doi.org/10.1186/s12913018-3516-9 Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2018). The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing. Journal of public economics, 163, 99–112. https://doi.org/10.1016/j.jpubeco.2018.04.009 Jain V. (2016). Time to take health economics seriously-medical education in the United Kingdom. Perspectives on medical education, 5(1), 45–47. https://doi.org/10.1007/s40037-015-0238-0 Jakovljevic, M. M., & Ogura, S. (2016). Health Economics at the Crossroads of Centuries - From the Past to the Future. Frontiers in public health, 4, 115. https://doi.org/10.3389/fpubh.2016.00115 Jakovljevic, M. M., & Pejcic, A. V. (2017). Growth of Global Publishing Output of Health Economics in the Twenty-First Century: A Bibliographic Insight. Frontiers in public health, 5, 211. https://doi.org/10.3389/fpubh.2017.00211 HEALTH Kino, S., & Kawachi, I. (2018). The impact of ACA Medicaid expansion on socioeconomic inequality in health care services utilization. PloS one, 13(12), e0209935. https://doi.org/10.1371/journal.pone.0209935 Moy HP, Giardino AP, Varacallo M. (2021) Accountable Care Organization. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448136/