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ACO vs. PCMH: The Right Pattern for Your Practice

May 11th, 2015 - By PrognoCIS Marketing

ACO vs. PCMH

Contrary to popular belief, the PCMH and ACO are very different. A PCMH model emphasizes delivery of care while an ACO is more of a payment model. However, both approaches share the common goals of lowering costs and improving patient outcomes. It is important to understand both models before deciding which one is right for a practice.

According to Medical Economics, a PCMH generally describes a practice that:

  • treats patients holistically
  • provides team-based care
  • coordinates care with other providers
  • focuses on safety and quality
  • provides patients with extended access to providers
  • engages patients in their healthcare

The PCMH approach seeks to make primary care accessible by decreasing wait times, increasing office hours, and providing after-hours access to providers through methods such as telephone or email. The PCMH model is dedicated to providing safe and quality care through decision-support tools, shared decision-making, evidence-based care, performance measurement, and population health management.

The greatest challenges most practices face in achieving PCMH status are finding ways to pay the additional staff, such as care coordinators and nurse practitioners, and implementing electronic health records (EHRs) and using them to exchange and analyze data. These challenges need to be taken under consideration when deciding to adopt the PCMH model.

The primary characteristics of the ACO model are:

  • an ability to manage both the cost and quality of services provided under a range of payment systems such as fee-for-service, episode payments, and full and partial population-based prepayment
  • a sufficient infrastructure and staff to support comprehensive and reliable performance measurements, make internal system improvements, and externally report on performance with regard to cost and quality of care
  • a commitment to achieving efficiencies in quality and cost
  • a physician management structure that is supportive of all requirements
  • a culture that supports and rewards quality improvement
  • health information technology used to manage patients in a range of care scenarios and across different institutional settings

In an ACO, providers receive a pre-determined payment to care for a designated patient population and meet quality targets. If the ACO can meet the quality targets for less than the payment, it gets to keep the difference. However, if it exceeds the payment, the ACO is responsible for making up the difference.

While a primary care practice can decide independently whether to adopt the PCMH model, an ACO requires a network of providers, thereby adding to the complexity and investment involved in its implementation.

Understanding the characteristics of each approach can help providers make the best decision for their practice.

Author: Lauren Daniels


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