Accountable Care Organizations Fail Because of these Reasons
The healthcare industry is an ever-changing environment. Which means that keeping up with regulatory standards and maintaining administrative workflows are essential reasons to your success. Additionally, with the current focus on value-based care, it’s no surprise why accountable care organizations (ACOs) make up 20 percent of Medicare beneficiaries. After all, the current industry is undeniably shifting toward a more value-based healthcare system. However, ACOs, especially newer ones, are not immune to industry challenges and organizational failures.
Despite the potential benefits that ACO programs provide, not every organization is fully up to the challenge. And with the demand for high levels of care coordination and patient outcomes, ACOs need to provide the best quality services while avoiding unnecessary costs. Which means that ACOs that can’t maintain high levels of care are putting themselves at risk of failure. Additionally, accountable care organizations also need to take advantage of every percentage of shared savings they can acquire. Luckily, advancements in management technology and management service providers now offer diverse solutions for these problems. In fact, any accountable care organization can succeed as long as it overcomes these significant challenges.
1. Quality Management
Accountable care organizations need to have the capabilities to evaluate and effectively manage the quality of their services. In other words, ACOs need to practice a time-tested and reliable quality management program. For example, some managed services organizations (MSOs) offer services in monitoring the frequency and results of your members’ care and services. In fact, an effective program should help any ACO provide the best quality of care for members and exceed health plan standards. After all, providing the best quality of care is essential for ACOs and value-based healthcare models.
2. Proper Compliance
Complying to industry standards and regulations is another important hurdle that accountable care organizations need to look out for. Considering the demanding nature of healthcare regulations and administrative requirements, ACOs need to oversee every aspect of their business. Additionally, you also need to oversee that the providers within your network comply with payer requirements and quality care. With this in mind, you need to stay up-to-date with state laws, healthcare guidelines, and other regulations. For this reason, ACOs need to have accurate audits, reports, and analytics. In fact, MSOs like Coordinated Health offer compliance services to help your organization stay updated and safe from penalties.
3. Staff and Communication
This may come as a surprise, but understaffing can cause major workflow problems especially in healthcare. After all, ACOs have a diverse set of healthcare and administrative tasks to worry about. As a result, the lack of staff and communication networks can negatively affect your daily processes. That’s why it's advisable for some ACOs to rely on administrative service providers like MSOs for extra support. Additionally, a platform for member and provider communications is also essential for success. After all, effective care coordination relies heavily on direct communication between providers, clinics, and members.
4. Revenue Cycle Management
You could be losing thousands of dollars in revenue if you’re not managing your data correctly. In fact, you could be missing out on billions of dollars because of coding and billing errors. And you wouldn’t even know it if you didn’t have the right tools. Whether it’s from past authorizations, claims, coding, billing, and more, ACOs need to find solutions for better revenue cycle management. You could start by upgrading to advanced management systems that offer extensive tools for data processing, analytics, and reports, or you can find management organizations that offer services that help you increase your accuracy and profits. After all, with the wide array of solutions available today, you have limitless opportunities to secure your organization’s success.
Why Choose Coordinated Health?
Coordinated Health is a management services organization that offers comprehensive management and administrative solutions for organizations within the healthcare industry. We utilize advanced technological solutions and innovative management techniques to provide diverse services that organizations like ACOs and IPAs need.
With Coordinated Health, your organization can:
- enhance the quality of your coordinated care services;
- reduce costs by mitigating redundant staff and services;
- gain cost-effective solutions for your specific needs;
- utilize advanced EHR services; and
- more.
Coordinated Health has the services that you need to succeed. Whether you need data analytics, technical support, or administrative services, Coordinate Health has the solutions for your specific needs. Contact us and discover more solutions and services.
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