As the aging population continues to grow, the number of people who need long-term care services is expected to double by 2020. Besides institutional care, alternatives including home- and community-based care multiplied exponentially as a result of the increasing demand for daily living support.
Elders who have chronic health problems often face challenges in financing and delivery. Groups of doctors, hospitals, and health care providers decided to join forces and tackle issues from duplication of services to medical errors. Voluntary in nature, these groups are called Accountable Care Organizations (ACOs).
ACOs are mushrooming across the United Sates. Dr. Patricia Gagliano, Chief Operating Officer of Right at Home South Shore Long Island, recently gave an informational presentation about them at the St. Joseph’s Hospital in Bethpage, New York on February 24. She also introduced myriad of integrated health care systems, including Fully Integrated Duals Advantage (FIDA), Delivery System Reform Incentive Payment (DSRIP), and Patient Centered Medical Home (PCMH) models, to a room of social workers, registered nurses and case managers.
While frontline healthcare professionals may have come across issues concerning the coordination of care for a patient, few have formal training on the subject. During the session, Dr. Gagliano compared the differences between Accountable Care Organizations (ACOs) and Health Maintenance Organization (HMOs), discussed the rights of Medicare patients regarding participation in an ACO and their choice of primary care physicians, specialists and surgeons.
Attendants of the lunch and learn event are particularly interested in the following questions:
Q. How to tell if a patient is a member of an ACO?
A. The answer might vary between different ACOs. In general, the hospital will have a list of physicians participating in ACOs and an ACO case manager will usually contact the social worker/case manager or discharge planner at the hospital.
Q. Can patient seek care from physicians who are outside of his/her ACO?
A. Yes, patients in ACO practices are not limited to staying within the practice of the network.