Benefit from Integrated Health Care and Accountable Care Organization models

by Barbara Weltman, attorney and author of The Complete Idiot’s Guide to Starting a Home-Based Business

Benefit from Integrated Health Care and Accountable Care Organization Models

Employers want affordable health coverage for their employees without sacrificing the delivery of health services. One option to consider is the integrated health care model in which the health plan, the hospital and the doctors work together in a coordinated way to benefit patients. 

The term “integrated health care” has been used to describe a variety of situations: the combination of traditional and alternative medicine, the provision of sick care and wellness under one umbrella, the treatment of physical and behavioral problems at the same time, etc. In this article, we discuss the four important benefits of the integrated health care model and the emerging Accountable Care Organization (ACO) model.

The Integrated Health Care Model: One Destination, Multiple Advantages

Benefit 1: More money devoted to patient care

The integrated health care model typically has lower administrative costs than the conventional fee-for-service model. In the integrated model, more of the premium costs paid by businesses or employees are used for patient care.

Benefit 2: More freedom for physicians

In an integrated health care model, doctors are not usually beholden to insurance companies and can determine care for patients as needed. In contrast, under the fee-for-service model, the insurance company decides the extent of care that a patient can receive, including the type of tests and the length of hospitalization.

An ancillary benefit of this point is that this model often attracts the best and brightest physicians who want to practice unencumbered by the dictates of insurance companies. 

Benefit 3: Access to records

The integrated health care model uses technology for the benefit of patients by allowing them to choose the appropriate health care provider — a clinic, doctor or hospital — while enabling the provider within the integrated system to easily view their patient’s medical records. In this, technology is used to leverage the work of a coordinated health care team. This use of electronic health records means that patients do not have to repeat or explain conditions, medications and other relevant information — it’s all in their records.

In contrast, under the fee-for-service model, even if technology were present, it may not be used to support the patient. It is not uncommon for duplicative tests and fees to occur from a lack in coordination between parties within the fee-for-service model.

Benefit 4: Wider range of services

Instead of only treating acute medical conditions, which is common practice in the fee-for-service model, the integrated model supports preventive care and a host of other services. Although the range of services varies with the particular provider, such services may include:

• Wellness programs that help to reduce unnecessary and inappropriate health services, and ultimately help to reduce the cost of health coverage to businesses and their employees
• Access to a doctor by emailing his or her office with routine questions
• Prescription refills online or by smartphone
• Educational materials for employees who are covered by a provider with an integrated health care model

The New Model of Health Care Delivery: ACOs

ACOs are a new type of delivery structure that puts the integrated health care model into operation. The ACO is a health care network made up of health care providers; such as hospitals, physician groups and health plans; that takes responsibility for patients by providing them with the range of care that they require. Such collaborative efforts provide care in a cost-effective manner and are designed to bring overall health care costs down, which ultimately should result in premium savings for patients.

The ACO model is currently being implemented for Medicare participants, and could be used in the near future for other health care consumers. However, it remains to be seen whether organizations that weren't conceived as part of an integrated model can achieve long-term success.

Conclusion

The integrated health care model may not be available in every location in the U.S. However, where it is a health care option, participants — doctors and other health care providers, as well as companies and their employees — find that the numerous benefits make this a good health care choice.

Barbara Weltman is an attorney, a prolific author with such titles as J.K. Lasser’s Small Business Taxes and The Complete Idiot’s Guide to Starting a Home-Based Business, and a trusted professional advocate for small businesses and entrepreneurs. She is also the publisher of Idea of the Day® and the monthly e-newsletter Big Ideas for Small Business® at www.barbaraweltman.com and host of Build Your Business radio. Follow her on Twitter @BarbaraWeltman.