Value-Based Care

An ACO is any healthcare organization that assumes financial accountability for the overall value, in terms of cost and quality, of care delivered to the population of patients/beneficiaries the organization’s providers serve.

Depending on how they are reimbursed, other transformative healthcare delivery models can be appropriately labeled as ACOs, including clinically integrated networks (CINs), select patient-centered medical homes (PCMHs), and population health service organizations (PHSOs).

While ACOs may be the most popular topic related to care model transformation, CINs rank a close second. The most notable characteristic of ACOs is the way in which they are reimbursed; however, CINs are primarily defined by the manner in which care is provided within the clinical delivery system. In the most general terms, a CIN is any group of providers that has effectively coordinated the clinical services provided to their patients across the care continuum.

“Patient-centered” refers to the model’s focus on understanding the comprehensive healthcare needs of each patient, involving patients in care plan development, and engaging patients in the management of their own health. “Medical home” relates to the model’s emphasis on the establishment of a deep relationship with a primary healthcare provider (and the care team embedded in that provider’s practice) who will be responsible for coordinating all of the healthcare services required by the patient.

Technically, a PHSO is any organization that provides the resources and programs to deliver rule-based care to effectively and efficiently manage the health of patient populations.

As the PHSO’s name implies, the model’s sole focus is the provision of population health services (e.g., engagement, outreach, education, care coordination, chronic disease management, complex case management).