Summary
An accountable care organization can be defined as a group of hospitals, doctors, and other healthcare providers, who organize themselves under one unit to voluntarily give coordinated, high-quality care to their Medicare patients. Their main aim is to ensure the sick get timely health care, preventing unnecessary duplication of services and minimizing medical errors. The participants of this organization come into agreement to take responsibility for the charged costs while receiving treatments. This leads to a reduction in the amount of money incurred. In some cases, the patient population can share the savings with the payer. Healthcare leaders and policymakers base their foundation on financial incentives to provide quality care, reducing the fee charged for services. However, some individuals argue that the main aim of ACOs is to reduce competition in the healthcare industry, which leads to increased costs for consumers. This planned structure allows the service to work with others in the care continuum to improve health status generally.
This paper considers a case scenario where a healthcare administrator is supposed to develop an evaluation plan to assess the probable impact of ACO build. Most importantly, it should aim at convincing the organizing board that this ACO will be in line with the organization’s strategy. Before this plan was suggested, the organization had made efforts to make necessary changes to put them on a successful path. They have already made substantial investments in physician participation and health information technology. Similarly, in reaction to health care reform, several contending hospitals in the locality are beginning to form ACOs to partake in new compensation models developed to lessen costs and enhance population health. Therefore, the essay discusses the evaluation and implementation of the ACO plan by examining the possible measures and methods to be applied. The challenges likely to be faced during the performance are discussed, and further better implementation strategies are proposed.
Importance of an Evaluation Plan
An evaluation plan is a documented method that guides the stakeholders in an organization in assessing the results throughout the entire project. The critical information needed in the project in the strategy development can be retrieved for easy decision-making. By doing this, time management is enhanced to ensure only the relevant information is gathered. Suitable methodologies and strategies that can be implemented in data collection can be identified, making the process easy (Balasubramanian et al., 2021). Additionally, a suitable and realistic timeline of events can be drawn to improve the intended initiative generally.
Measures for the Evaluation Plan
Identifying Program Objectives and Goals
The first and most important measure taken in plan evaluation development is the identification of the objectives and goals of the organization. These are the desired achievements that must be attained within a specified period of time. It can be best developed by evaluating the problems which the organization is facing and that need immediate attention. For instance, long-term investment plans can solve the challenge of finances required for the construction of hospital facilities. In collaboration with other stakeholders, the director can implement strategies that ensure the proper utilization of funds acquired (Guise et al., 2021). Government interventions can occur that offer financial aid to development.
An organization that has clear and realistic goals has reasonable pathways to follow to achieve them. Communicating these set objectives to the other members encourages collaboration and teamwork and the creation of a desired course of action. Additionally, setting specific goals enables organizations to evaluate the performance of healthcare workers and the quality of services they offer (Balasubramanian et al., 2021). Gaps of developments that have been ignored for an extended period can be taken care of, leading to a better state of the healthcare facilities.
Setting clear goals and objective help in the planning process, which can be modified with time. It reduces the chances of risks that are likely to occur in the course of implementing the set goals. Future changes can be predicted by examining past events which might have affected the plan negatively (Miller et al., 2021). Activities that waste time are avoided since they create chaos and confusion. Creativity is enhanced since the root of planning begins at the organizational level. New encounters with challenging life events make affected individuals think beyond their imagination and develop new ideas.
Developing Evaluation Questions
Evaluation questions are developed to examine the main concerns discussed during the evaluation and implementation process. They are mainly determined after the goals and objectives of any program have been suggested. Evaluation questions give the administrator and other board members direction about the Accountable Care Organization (Luchini et al., 2020). These will be classified into three; first, the ACO was setting indicating the place the contract will operate, the ACO activities involved, and its characteristics.
Some of the features of ACO comprise the scope, which explains the extent of the research area. The above includes a specification of the parameters of the research operation. Incentive design shows how finances will be spent across the development projects which are involved in making the program a success. Risks that are likely to occur in the course of action should be accounted for to avoid gaps that may emerge due to spending on unwanted phenomena (Miller et al., 2021). There are four main groups of evaluation questions that can be asked during the process of gathering information. They indicate a possible methodology that can be used while collecting data in the field.
Planning and Implementation Issues
These evaluation questions tend to answer how effective an initiated program will work. The types of participants to be involved are suggested, and their diversity is considered. This will ensure all the members of the society are well represented. Reasons for why the selected population is chosen are given regarding the community satisfaction with the services offered. The importance of these questions is seen in their aim to improve every individual’s overall health status despite cultural diversities.
Assessing Attainment of Objectives
The success of any project is measured by the level of attainment of the set goals and objectives. The number of people who have shown interest and participated in the program indicates how well the objectives have been attained. The amount of time spends by the target population in the fields dictates the effectiveness of the research needs and gaps. Any organized activity that fails to involve community participants can be null since the individuals have not been represented.
Impact on Participants
This refers to the change felt in the community due to initiating an essential activity. Behavioral changes that have occurred due to the community members involving themselves in the projects can give a review of the overall program. Possible negative impacts which might have happened during the participation should be considered and improved. All these activities are majorly aimed at enhancing society’s view on health and possible disease remedies.
Developing Evaluation Methods
For one to collect relevant and authentic data, suitable research methodologies must be applied. Evaluative research deals with the systematic assessment of the value of money, resources, and efforts to achieve set goals. This type of evaluation occurs within an organization and requires management skills, team spirit, and interpersonal cooperation. Its positive impacts are seen when the stakeholders’ interests are kept in mind and effectively tackled. Since it is an applied research methodology, it affects real life, and more practical methods should be adopted.
Methods
Data
A distributed data model approach will be the most suitable methodology to adopt. In this method, the payers involved will be required to calculate the general performance of the covered and the uncovered members. Comprehensive information will be needed to examine data concerned with the widespread impact of the participants involved. Adopting affordable strategies can track the available cost incurred during the process. Critical data collection strategies, such as qualitative evaluations and case studies, and quantitative methods, such as surveys, are suitable.
Research metrics refer to the various quantitative tools which can be used to assess the impact and quality of research outputs. An example of research metrics that would be used during the exercise are; citation analysis, bibliometrics, and altmetrics. Bibliometrics refers to the evaluation of published books and articles to get information. Citation analysis investigates the quality and impact of a report based on the author’s intentions. Altmetrics considers the online reading behavior of an article and its influence on the readers.
Behavioral Surveys
A survey applies the deductive approach whereby the information collected from a selected sample represents the total population. Behavioral surveys indicate the harmful activities individuals are exhibiting. The extent of the damage caused due to these characters is examined. For instance, in the fight against diseases, some individuals in society could be going against this slogan by engaging in harmful health practices like drinking excess alcohol. They track changing behaviors of the target group, making it easy to develop strategies that discourage negative traits.
Interviews with Key Participants
This refers to structured questions established on the asking and answering questions concerning a particular topic. Some of the participants have more extraordinary experiences concerning the research topic, and their viewpoints can be essential. The historical perspectives and factors affecting health can be used to predict current changes to improve healthcare services (Döringer, 2020). The importance of using this method is the ability to provide detailed information. Verbal communication in the conversation leads to positive interactions with the other community members. Peace ensures the harmonious existence of all people despite their differences.
Experimental Evaluation Designs
Experimentation involves the application of scientific methods to collect and analyze data. A randomly selected is chosen, and their information is tested for verification. The importance of experiments involves the proof of existing theories to give a basis for the known scientific knowledge. It facilitates better decision-making on the proposed hypotheses caused at the beginning of any trial. This leads to the establishment of valid scientific principles which explains various day-to-day occurrences.
Setting a Timeline for Evaluation Activities
A timeline of events gives a chronological arrangement of activities in the manner they should occur. A clear picture of the intended actions enables proper decision-making strategies, which improve the status of the recent project. The starting time of a task can be tracked and its due, and most importantly, if it depends on another risk for necessary precautions. This avoids confusion cases that are likely to occur due to poor planning.
Timeline
Creating and running an ACO needs sufficient time, which will be used in managing risk during the transition process. Significant efforts should be applied to the target activities for higher performance in the implementation needs. Additionally, precautionary measures must be included to deal with emerging issues such as the COVID-19 pandemic. Since the project is large and has many credentials, the timeline of activities can run between five to seven years to be entirely successful and operational.
Creation of a Value-Based Strategy (5-8) Months
This is the first phase of planning, and it will be helpful in the development of well-laid strategies for the operation of the program. Necessary benchmarks and organizational consensus will illustrate a competency-based plan like setting consumer experience goals, clinical leadership, ACO design of work, and financial model. Additionally, technological developments cannot be left out since they have led to time-saving medications. Patient care-based models have improved clients’ safety in caring for patients during critical periods.
Creation of the ACO 8-11 Months
The costs incurred in the development of an ACO are most likely to be less in the beginning and increase as time goes by. This is because of the changing trends of life, which come with more urgent needs that require immediate attention. Staff relocation will be experienced to allow interaction and collaboration. This promotes teamwork and connections among all the stakeholders. Staff relocation from one unit to another lead to all-around healthcare professionals who can be utilized in any section for the treatment’s functions. New interactions among the care providers and physicians will create a conducive working environment for all patients.
Revenue earned and finances set aside for this exercise will be utilized in dealing with challenging issues and documentation to maintain proper records. Already available infrastructure will act as the foundation for a patient-centered care system that the ACO aims to develop. Individuals who have experience in health planning will be hired to evaluate and analyze insurance impact and the metrics used. To uphold high levels of integrity in the health plan participants, ACO must apply actuarial capabilities to investigate the allocation of costs of care and administrative expenditures.
A third party may be engaged in the beginning for the purpose of investigation. Primary care physicians will lead the operation and get sponsorship from the existing health systems. With time, ACO will take bundled payments for exceptional care, such as for patients with existing conditions. A specialty ACO model will be developed to offer high-value primary care and specialized clinical practices.
Generating Initial Cost Savings and Quality Improvements (12 to 26 Months)
The health system will begin implementing the ACO program to reduce production costs incurred in this stage. A performance tracking system would back up specified and measurable targets which would have been created. Incentives will encourage the management system to achieve improved care at a cheaper cost. Revenue-based teams will be eliminated from the office, and training on new skills in values be done. This will be beneficial in optimizing communication and financial performance more effectively with the clinician’s aim to achieve set targets. The ACO’s main strategies will focus on areas of specialization like diabetes management and maternal care.
Managing the Transition to Risk (27 to 46 Months)
A contract based on the effective plan will be designed to reduce costs by eliminating unnecessary expenditures. Prices reduction and market expansion improve the value of services to consumers. This timeline stage will need the application of patience since it will take almost a year for ACO to realize a sustainable reduction in health costs. Risk-taking strategies enable ACO to think about the organization’s future to be on track toward success.
Performing as a Risk Manager (Five to Seven Years)
The manager is responsible for giving directions on what should be undertaken at a particular stage. They act as the leaders and motivators in gearing other members in collaboration and coordination. This stage will mainly focus on continuous performance improvement and examination of possible challenges and solutions. Geographical expansion to other populations in the community will need the development of a new level of data collaboration and sharing by physicians.
Evaluation of Timeline
The ACO management will be responsible for examining the progress which has been realized by all stakeholders involved in the plan. The ACO will compute evaluation outcomes every quarter and annually to track performance and reconcile expenditures. The organizing leader is required to write a report indicating the contributions of each member, utilization cost, total spending, and adequately defined quality indicators. Comparing the rate of expenditure across the years can give a clue and prediction of future financial management methods.
Challenges Likely to be Faced
Unequal Resource Allocation
Resources in the form of finances are required to cater to the needs which may occur during the program evaluation and implementation. ACO leaders will be needed to draft a budget that will indicate how the money will be utilized across performance phases. However, due to emerging catastrophes that might not be accounted for, inadequacy in finances will be felt. Improper planning is a significant contribution to financial management problems, as ACO leaders will need to agree on how to distribute shared savings equally (Kamal et al., 2021). Funds can be mismanaged by the people in authority, especially those given the mandate to budget for them.
Inadequate Management Support
Another common challenge that can be experienced is inadequate support from the management. The concept of leadership in an organization follows a specific hierarchy where authority flows downwards. Therefore those in such positions must possess leadership skills that will enable them to give a sense of direction to others. When they do not engage other stakeholders in the decision-making process, barriers to success are created. Management support should be included early in the planning process to be fully accounted for. The leaders in each level of power must know their roles and be willing to offer help whenever it is needed. Several strategies for ensuring management support takes place should be laid. Firstly, administration illustration must be contained on the employee healthiness committee as an indication that management is dedicated to its victory. Secondly, managers should be interviewed to prove their expectations in the programs and ascertain whether they match the set objectives. Lastly, continuous communications with managers should keep track of ongoing events.
Inadequate Staff Resources
Healthcare involves the utilization of human resources, beginning with the clinicians, the support staff, and the community members. Doctors are responsible for the treatment process by diagnosing diseases and medication processes. On the other hand, nurses work together with doctors by offering patient care services such as monitoring health record progress. Insufficient healthcare personnel leads to poor service delivery increasing death cases. The support staff provides general services such as food preparation for the sick and cleaning duties. Their contributions to the hospitals are immense, and services might come to standby without their presence (Ballesio et al., 2020). On the other hand, the community members set standards of operation for the organizations. They must adhere to the existing cultural setup; failure to do so can bring inevitable consequences.
However, in some cases, the existing staff may be unwilling to adopt the culture, which becomes a management barrier. Conflicts might occur between society and the organizations affecting the general impact created. The community can refuse to embrace change which occurs predominantly in the healthcare sector. For instance, some members of society do not believe in the use of modern medications to cure illnesses. Instead, they prefer using traditional herbs since they feel that they have lesser side effects.
Additional Strategies to Ensure Implementation and Evaluation
Improving Stakeholders Participation
Strategic plans can only be achieved by ensuring the participants involved are active in undertaking the programs. Reasonable efforts in planning can help organizations overcome problems arising from low participation. Failure to develop an interest in the activities by the stakeholders can hinder it from achieving its goals. Participation can be improved by involving them in decision-making and responding to the grievances they come with. Most importantly, a stakeholder wellness committee can be created to act as morale for the members. The presence of unions can be crucial to promoting coordination with local representatives to comprehend their priorities and incorporate them into the planning process. For example, the manager of the ACO organization can organize meetings with other stakeholders like the nurses, doctors, and the support staff and listen to their issues. In some cases, participants in the lower places are never allowed to share any information with those in leadership positions due to fear and position.
Educating the Public
Illiteracy is another barrier to practical evaluation and implementation processes. This mainly occurs when the public members fail to support the proposed programs as they are unaware of the benefits associated with them. To ensure support from the people, education programs can be set to create awareness of what is being implemented and the importance of adopting it (Alberti et al., 2021). Further, participants should be given platforms to give their suggestions on the ongoing programs. Through this, they might develop other ideas that might not have been suggested before. For example, in the fight against the increased cases of patients with existing conditions such as diabetes, people can be educated on preventive measures. Some of these precautions include eating a balanced diet and exercising regularly.
Conduct More Effectiveness Research
Technological advancements in the healthcare profession lead to new methods of treating patients. In the implementation plan, research should emphasize cheaper means to improve the current health status. Devices that healthcare providers use need modification to be more efficient and fast (Riaz et al., 2020). This will save time and rate of service delivery and reduce death cases. For example, ACOs should aim at developing patient portals where clients’ information is stored online. High-sensitive passwords should be set to protect data from being attacked by outsiders who seek to distort the stored data. Patients can interact with doctors online and receive medical prescriptions without visiting the doctors physically.
Contribution of the Evaluation Plan to the Feedback Loop
To track the performance of the ACOs, feedback is essential in evaluating what has been fulfilled and the existing gaps. Emerging issues that need immediate feedback can be identified by examining the timeline of events. Feedback will therefore be determined by two critical aspects of performance, outcomes of care and the interests of the existing population (Moore & Campbell, 2021). The contributions of each of the players must be examined to ascertain whether they have undertaken the assigned roles as stipulated. Because of the above, those individuals who have failed to comply with their tasks can be warned.
Additionally, feedback efforts will track the effects of the accountable care model on the target populations, especially the ones who are vulnerable. For example, the ACO taking care of patients who have diabetes would face hard times knowing the progress of these victims if they fail to ask for their feedback and possible changes. However, setting well-organized systems to examine the feedback will improve patients’ experiences and management of the ACO.
Workers’ experiences while interacting with patients can provide alternative management strategies for the ACO. The stakeholders will be able to oversee emerging problems in the future by examining their present states and the responsibilities accredited to them during those periods. Inspiration for motivational progress is realized by reading about the achievements attained through learning and discovering new ways of dealing with the sick, and improved management strategies are learned.
Relevance of the Evaluation Plan
The main aim of ACO is to participate in the new payment models, which are designed to improve the population’s health and reduce the cost incurred in the treatment process. To ensure the evaluation plan proposed is aligned strategically with the ACO mission, clear goals and objectives will be set and confirmation that all the stakeholders are aware of them. To reinforce this, I will organize a meeting with the team and discuss whether the objectives are realistic and achievable. Further, communication on the set goals at each level of achievement will be emphasized.
Help will be offered to the available stakeholders to enable them to achieve their desires. Necessary resources and tools to run the program efficiently will be provided, and if improvements are needed, I will correspond appropriately. Continuous training of the personnel on the current technological trends will be adopted. Additionally, offering guidance and counseling services to the people involved will be vital in promoting a conducive work environment. The individuals will equip themselves with better methodologies to deal with stressors in the workplace.
The importance of aligning the evaluation plan is realized since only the relevant activities will be done. Time management strategies will be adopted, and more tasks will be accomplished within the proposed timeline. Improved technology in healthcare will make the treatment process first and more effective. The easy retrieval and storage of patient data will be facilitated hence enhancing the quality of services. Tracking the trends in the healing process will improve overall clinical outcomes. Most importantly, medical errors will be minimized. Continuous training equips healthcare professionals with relevant skills and knowledge to improve their mode of delivery.
In conclusion, it can be seen that a successful ACO evaluation plan should be a collaboration between all the stakeholders involved. A distributed data model approach will be the most suitable methodology to obtain data. The evaluation plan is a document that contains all the procedures to be followed in order to establish a valid ACO. Some of the measures taken to develop a better plan include the identification of program objectives and goals that are realistic and measurable, developing evaluation questions, and setting up the project timeline.
Challenges that might be experienced include inadequate funding to cater to diverse needs. Mismanagement of funds by the people in authority, lack of management support, and insufficient human resources. All of these act as barriers that drag the evaluation and implementation of the ACO. Additional strategies to ensure performance and assessment of the plan include; improving stakeholders’ participation in the project, especially by involving them actively in the decision-making process.
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