Scenario: Your hospital has an opportunity to participate with an Accountable Care Organization (ACO) contract with 50,000 ACO patients. The ACO patient population expects about 5,000 avoidable hospitalizations per year with a potential savings of $50 million, which will be shared as follows: 50% revenue to the insurer and 50% revenue to the hospital. The ACO patient population will require an average of six office visits per year, and 300,000 total office visits will need to be supplied by your primary care workforce.
In a 2- to 3-page Word document that includes tables and/or calculations, make recommendations on the following: 1) number of physicians and nurse practitioners needed; 2) reimbursement method: salary or fee-for-service; 3) recommendations for financial incentives to address the challenges of supplier-induced demand and how to ensure efficiency. Interpret the net profit from the ACO contract based on your recommendations. Explain the rationale behind your recommendations, including the impact made by your financial calculations.