Reviewing Classmates Post

I need a commented response to the following post. If ANY sources used please they must be easily accessible for the professor.

Original Post:

I would recommend a service oriented startup to assist in ensuring compliance with ACO agreements. I feel that the primary goal of an ACO is to streamline the costs associated with particular conditions, and to focus more on preventing the need for additional care rather than getting paid for services provided, as part of the Triple Aim. This is because this is an agreement between a healthcare payor (insurer) with the providers. With an ACO, typically healthcare organizations are only given a set amount per patient, which varies depending on the conditions that the patient has, although there are several reimbursement models that CMS uses (Centers for Medicare & Medicaid Studies, 2020). Medicare and Medicaid arent the only payers that enter into ACO agreements, some large payors are also trending to them as well, such as Blue Cross Blue Shield of Texas (Shinneman, 2018). This could be due to the disruptive innovation brought forth by the ACA creating insurance exchanges, creating a greater need for insurance companies to compete to offer better benefits at a lower cost (Wanamaker, 2013).

The reason that I think that a startup focused on maintaining these agreements is mainly due to the market size of the health IT consulting industry, how new ACO agreements are to the sector, and the growing incentive to push these types of agreements instead of fee for service models. There are already companies that have solutions for the compilation of health data that would need to be reported as part of ACO agreements, and the EHR vendors would probably have an incentive to make this data available if they wanted to retain existing customers and acquire new customers, or perhaps create tools to allow customers to compile the data requested by the ACO agreements themselves. The sale of services is probably a bit easier than the sale of the software as well, since you would be better able to directly correlate the services that are offered with the increased return that they would bring.

References:

Centers for Medicare & Medicaid Studies. (2020, January 30). Accountable Care Organizations (ACOs): General Information. Retrieved February 6, 2020, from https://innovation.cms.gov/initiatives/ACO/

Shinneman, S. (2018, July 25). Baylor Scott & White’s ACO Signs A Deal With BCBSTX. Retrieved February 6, 2020, from https://www.dmagazine.com/healthcare-business/2018/07/baylor-scott-whites-aco-signs-a-deal-with-bcbstx/

Wanamaker, B. (2013, September 30). Disruptive Innovation and the Affordable Care Act. Retrieved February 6, 2020, from https://thehealthcareblog.com/blog/2013/09/26/disruptive-innovation-and-the-affordable-care-act/

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