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Brandon Sim
Department of Medicine, Apollo Medical Holdings, Alhambra, California, United States of America
Publications
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Research Article
A Data-driven Approach to Revamp the Accountable Care Organizations (ACO) Risk Adjustment Model
Author(s): Yubin Park*, Kevin Buchan, Jason Piccone and Brandon Sim
Accountable Care Organizations (ACOs) involve groups of healthcare providers, who voluntarily come together to deliver coordinated, high-quality care to aligned beneficiaries. Many ACOs, such as the Medicare shared savings program and the ACO REACH program, can participate in alternative payment models that differ from the prevalent Fee-for-Service model. In these alternative payment models, providers and payers share financial risk to align the ACOs’ financial incentives with the dual aims of reducing the total cost of care and improving the quality of care. In other words, ACOs could profit by keeping their patients healthy and preventing unnecessary hospitalization. However, to make this financial structure work as intended, there needs to be a Risk Adjustment (RA) model to change reimbursement proportional to a beneficiary’s risk; otherwise, ACOs m.. View more»