MHA 508 University of Phoenix Navigating the Regulatory Environment in Health Care Paper

Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare & Medicaid Services to help facilitate this cooperation.

Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).

Write a 700- to 1,050-word executive summary that discusses the purpose of joining an ACO and the funding available through one. Ensure your summary does the following:

Describe the organization you selected and the general services that would be offered to Medicare patients.

Describe the types of ACOs recognized by the Centers for Medicare & Medicaid Services.

  • Evaluate industry dynamics that would influence your organization’s decision to participate in an ACO.
  • Identify the steps needed to participate in an ACO.
  • Justify participation in an ACO for your organization.
  • Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Expert Solution Preview


Title: Joining an Accountable Care Organization (ACO) for Medicare Patients

As the healthcare industry continues to evolve, collaboration and coordination among healthcare organizations have become crucial in providing quality care to Medicare patients. This executive summary aims to discuss the purpose of joining an Accountable Care Organization (ACO) and the funding opportunities available through such an organization. The selected type of healthcare organization for this analysis is a hospital. By participating in an ACO, hospitals can enhance care coordination, improve patient outcomes, and efficiently manage Medicare reimbursements.

Organization and Services:
Hospitals play a critical role in the healthcare system and are essential in meeting the complex needs of Medicare patients. They offer a comprehensive range of services, including inpatient care, surgery, emergency care, diagnostics, and specialized treatment for various medical conditions. By joining an ACO, hospitals can align with other healthcare providers to ensure seamless transitions of care, reduce duplicative services, and enhance overall patient experience.

Types of ACOs Recognized:
The Centers for Medicare & Medicaid Services (CMS) has recognized several types of ACOs that hospitals can participate in. These include Physician-Led ACOs, Hospital-Led ACOs, and Integrated Delivery System (IDS) ACOs. Each type has its unique characteristics, governing structure, and requirements. Physician-Led ACOs focus on primary care physicians as the primary decision-makers, while Hospital-Led ACOs emphasize the hospital’s leadership in care coordination. IDS ACOs, on the other hand, involve multiple healthcare providers under common ownership or contractual arrangements.

Industry Dynamics and Decision to Participate:
Various industry dynamics may influence a hospital’s decision to participate in an ACO. These include changes in reimbursement models, the need for care coordination, the desire to enhance patient outcomes, and the potential to improve financial performance. By joining an ACO, hospitals can benefit from shared savings opportunities, gain access to valuable data and analytics, and collaborate with other providers to develop innovative care models.

Steps to Participate in an ACO:
To participate in an ACO, a hospital needs to follow certain steps. Firstly, it must evaluate its readiness and capacity for managing population health and coordinating care. This may involve conducting an internal assessment of infrastructure, care processes, and data analytics capabilities. Secondly, the hospital needs to establish partnerships and network with other providers within the ACO. This collaborative effort ensures effective care coordination and communication channels. Thirdly, the hospital must engage in quality improvement initiatives to meet the ACO’s performance measures and achieve financial rewards.

Justification for ACO Participation:
Participating in an ACO offers numerous benefits for hospitals. Firstly, it helps improve care coordination and transitions, promoting better patient outcomes and reducing unnecessary hospital readmissions. Secondly, it provides financial incentives through shared savings arrangements and pay-for-performance models, which can enhance the hospital’s financial stability and sustainability. Moreover, joining an ACO allows hospitals to engage in value-based care and population health management, aligning with the shift towards more holistic and patient-centered approaches.

1. American Hospital Association (AHA). (2021). Accountable Care Organizations. Retrieved from [insert URL]
2. Centers for Medicare & Medicaid Services (CMS). (2021). Accountable Care Organizations (ACOs). Retrieved from [insert URL]
3. Healthcare Financial Management Association (HFMA). (2021). ACOs: The Basics. Retrieved from [insert URL]

Note: The URLs have been left empty intentionally. The references should be filled with actual reputable sources for the finalized assignment.

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