At Advanced Management USA, we have always recognized the critical role of Accountable Care Organizations (ACOs) in driving value-based healthcare. As the healthcare landscape continues to shift, the significance of ACOs has only intensified. Initially formed to improve healthcare outcomes while controlling costs, ACOs now face an even more urgent mandate: delivering consistently high-quality care. With the stakes higher than ever, ACOs must meet stringent quality benchmarks or risk losing out on shared savings altogether.
In this article, we explore why the pressure on quality has escalated, and how Advanced Management USA’s ACOs are uniquely positioned to thrive amidst these challenges, particularly in light of key industry issues highlighted by Stephanie Mercado, CEO of the National Association for Healthcare Quality (NAHQ) (Modern Healthcare).
The Current Quality Crisis
As Mercado emphasizes, the healthcare industry is grappling with a “crisis of competency” in meeting quality standards. Despite years of effort, the system remains fragmented, leading to inconsistent delivery of care. Alarming statistics reveal that one in four Medicare patients experiences an adverse event during a hospital stay, with nearly half of these events being preventable (NAHQ). These figures underscore the systemic nature of the problem and highlight the critical role ACOs can play in unifying quality efforts across providers.
Why ACOs Are Critical
ACOs, especially those under Advanced Management USA, are designed to overcome the very challenges Mercado identifies. ACOs prioritize integrated, coordinated care that aligns multiple providers around shared goals: improving patient outcomes while reducing unnecessary costs. The financial structure of ACOs—where performance-based shared savings are contingent on achieving quality benchmarks—creates a powerful incentive for consistently delivering high-quality care. This is where we excel, ensuring that our ACOs not only meet but exceed these metrics, safeguarding both patient outcomes and financial sustainability.
Unlike traditional fee-for-service models that prioritize volume, ACOs operate within a value-based framework. Advanced Management USA’s ACOs leverage this framework to address today’s pressing quality concerns head-on. By focusing on population health management, preventive care, and chronic disease management, we reduce inefficiencies and improve care coordination, all while maintaining rigorous attention to the quality metrics set by CMS.
Tackling the Workforce Cliff and Escalating Costs
The healthcare system is also facing a workforce crisis. Mercado’s analysis of the “workforce cliff” is particularly relevant to ACOs. As the population ages and the ratio of working-age individuals to retirees shrinks, the demand for care will outpace the supply of healthcare workers. ACOs are well-positioned to mitigate this challenge through smarter care management and operational efficiency. Advanced Management USA has already invested heavily in innovative solutions, such as telehealth and care coordination tools, that enable our ACOs to extend care without overburdening providers (Modern Healthcare).
Rising healthcare costs present another challenge that ACOs are equipped to address. With a model focused on reducing unnecessary services, such as avoidable hospital readmissions, ACOs play a vital role in curbing costs. Advanced Management USA’s ACOs have proven their ability to not only achieve savings but also reinvest in care improvements, creating a virtuous cycle of cost reduction and quality enhancement.
The Need for Standardized Competency in Quality
One of Mercado’s most pressing points is the lack of a standardized competency framework in healthcare quality. The piecemeal approach many organizations have taken to quality improvement has led to a lack of cohesion and inconsistent results. ACOs, however, are positioned to lead the charge in promoting uniform quality standards. Advanced Management USA has already adopted comprehensive frameworks, such as NAHQ’s Healthcare Quality Competency Framework, across our ACO networks, ensuring that we are aligned around proven, standardized metrics that drive better outcomes (Modern Healthcare).
By embracing these quality frameworks, our ACOs are not only setting a new standard within the MSSP program but also serving as models for other healthcare organizations. This standardization not only improves outcomes but provides a clear, measurable path to success in value-based care.
Conclusion: ACOs as the Future of High-Quality Healthcare
The healthcare system stands at a pivotal crossroads. The need for cost-effective, high-quality care is more urgent than ever, and ACOs are uniquely equipped to meet this demand. As Stephanie Mercado and other leaders in healthcare quality have pointed out, the challenges of adverse patient events, rising costs, and a shrinking workforce require bold solutions. ACOs are at the forefront of those solutions.
At Advanced Management USA, we understand that achieving high-quality scores is not just about meeting regulatory requirements—it’s about ensuring the sustainability of our ACOs. The financial success of our ACOs is inextricably tied to our ability to deliver excellent care. By staying at the cutting edge of care coordination, quality measurement, and value-based innovation, we are ensuring that our ACOs not only meet today’s challenges but shape the future of healthcare.
The path forward demands continued adaptation, innovation, and a steadfast commitment to quality. At Advanced Management USA, we are prepared to lead the way, demonstrating that with the right strategy, ACOs can deliver the high-quality, integrated care that our healthcare system so desperately needs.
