Paper Example: The Future of the ACOs

Hennepin Health is an Accountable Care Organization (ACO) that was established in 2012 by Hennepin County in Minnesota to provide health services to Medicaid beneficiaries. The organization is devoted to proper coordination of medical and nonmedical interventions to control the cost of medical services and improving outcomes. The organization is notable in the provision of primary and essential healthcare services the low-income earners (DeCubellis, 2017). Besides being among the most growing institution among the safety-net health systems, it has some challenges (Hennepin County, 2002). This paper evaluates the challenges faced by the organization, the available opportunities, and proposes possible solutions.

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Service Provision to Non-Members

The Current regulations at Hennepin Health do not allow patients who are not members of the organization to receive medical services from its providers. This requirement is against the practitioners' will to help the people in need of their services and it is also against the rights of patients. The provision of paid services to non-members is a viable opportunity for Hennepin to invest and get some income, which will supplement the state and federal government budgetary allocation for the facilities. It shall provide medical practitioners with an opportunity to serve the rest of the population (Clark, 2014).

Consistent Documentation

Another challenge faced by the organization is a lack of consistency in keeping medical records by other medical institutions in the electronic health records (Regina et al., 2019). This issue affects Hennepin Health since the organization takes an integrative medical approach and considers customers' medical history, behavioral health and social service requirements. These records are necessary since Hennepin serves its members through a multidisciplinary team of doctors, pharmacists, nurses, community health workers and social workers; hence they need a proper health record system not only within their organizations but also for other medical institutions (Winkelman & Chang, 2018). An opportunity in this sector is to develop a universal electronic medical health record system that is legal and all health care providers will be required by the government to comply. This way, patients' health records will be readily available for easy diagnosis and delivery of service to clients. This investment opportunity will also be a solution to the above-discussed challenge.

A Desire for More Collaboration

Stakeholders at Hennepin feel that is a lack of collaboration between health care providers since there is limited sharing of data. This aspect creates a competitive environment for them instead of a collaborative one hence affecting service delivery; for instance, sharing of patient data and history is essential for current and future diagnosis. Therefore, the lack of it is a setback to the medical fraternity. Sharing of data is critical for reducing duplicate testing readmissions and avoiding common medical errors, therefore, providing accountable healthcare for the citizens (Blewett & Owen, 2015). It can be implemented through the use of electronic health records (EHRs) and information technology (IT) systems. This aspect will provide an opportunity for IT providers to invest and also a solution to secure data sharing. It should be noted that data sharing must comply with set regulations to record, store, and transfer patient data securely among medical professionals (Rosoff & Leong, 2016).

Medicaid Program Challenges

Due to the absence of Medicaid from these value-based purchasing incentives, it is challenging to redesign services where there is a lack of uniform state and federal payment models (Vickery et al., 2020). This way, service provision becomes restricted to membership and service terms. The recommended solution to this challenge could be the redesigning of the terms of engagement to enhance value in purchasing incentives.

References

Blewett, L. A., & Owen, R. A. (2015). Accountable care for the poor and underserved: Minnesota's Hennepin Health model. American Journal of Public Health, 105, 4, 622-4.

Clark, C. (2014). Homelessness: Prevalence, impact of social factors and mental health challenges. New York: Nova Science Publishers.

DeCubellis, J. (2017). Hennepin Health-An Accountable Care Model for Vulnerable Medicaid Populations. North Carolina Medical Journal, 78, 4, 243.

Hennepin County (Minn.). (2002). The state of the safety net in Hennepin County: Part 1. Minneapolis, Minn.: Hennepin County, Center for Health Policy & Community Services Integration.

Regina, R., Romaire, M., Hersey, C. L., Parish, W. J., Kissam, S. M., & Lloyd, J. T. (2019). Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts. The Milbank Quarterly, 97, 2, 583-619.

Rosoff, P. M., & Leong, K. M. (2016). An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients. The Journal of Law, Medicine & Ethics, 43, 4, 857-877.

Vickery, K. D., Shippee, N. D., Menk, J., Owen, R., Vock, D. M., Bodurtha, P., Soderlund, D., Linzer, M. (2020). Integrated, Accountable Care for Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health. Medical Care Research and Review (MCRR), 77, 1, 46-59.

Winkelman, T. N. A., & Chang, V. W. (2018). Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions. Journal of General Internal Medicine, 33, 3, 376-383.