Are Health Insurance ACOs Failing?
What are Health Insurance ACOs? By definition, an Accountable Care Organization (ACO) is a type of healthcare organization that is characterized by a payment and a care delivery model that seeks to tie physician reimbursement to certain quality metrics and reductions in the total cost of care of a particular patient population. Health Insurance Accountable Care Organizations are organizations that specifically partner with health insurance companies. For the study, I did a complete analysis and comparison of 10 of the most well known health insurance ACOs and Non-ACOs in the country. Below, you will find a summary of the overall results. The raw data from my study will be published in the next 9 posts.
Health Insurance ACO Study Results
1) Health Insurance ACOs admit more patients to the hospital than Non-ACOs.
2) More patients visit the Emergency Room of Health Insurance ACOs than Non-ACOs.
3) Patients of Health Insurance ACOs stayed in the hospital longer than patients who went to Non-ACOs.
4) Non-ACOs generated more patient revenue than Health Insurance ACOs.
5) Non-ACOs generate more profit than Health Insurance ACOs.
6) Health Insurance ACOs have a higher readmission penalty (average) than Non-ACOs.
7) Health Insurance ACOs will loose more money than Non ACOs as a result of their higher readmission penalties.
8) Health Insurance ACOs readmit more patients to the hospital (on average) than Non-ACOs.
9) Health Insurance ACOs have a higher hospital acquired infection rate (on average) than Non ACOs.
Health Insurance ACOs Have Failed
Above is a summary of my study results. The next nine posts will contain the raw data collected from the study. Based upon the above results, it is clearly evident that Health Insurance ACOs are failing to do what they are supposed to do. For example, re-admission rates should be low and instead they are higher. Hospital acquired infection rates should be low when instead they are higher. Length of stay days should be low when instead they are actually higher. Low re-admission rates, low hospital acquired infection rates, and low length of stay days are crucial to the success of this type of organization. Many of the ACOs and health insurance companies listed in my study have spoken publicly stating that they have in fact reduced the rates listed above but there is no evidence to suggest that they truly have. My research shows the truth and it is therefore clearly evident that the ACOs are truly falling. If hospital executives are wise (which they of course they are) and care about their facility and patients, they should not let their facility get involved with an insurance company managed ACO.