The term managed care organisation refers to a group of medical providers and facilities that provide care to its members at a reduced cost, this group requires a primary care provider to be successful. On the other hand, accountable care organisation refers to a group of medical providers and medical facilities that work or collaborate to offer the provider a collaborative care to its members.
There are several differences and similarities attributable to these two concepts as outlined below:
First and foremost, in the case of managed care organisation it is a requirement to notify the beneficiary before any business undertaking this is true also for accountable care organisations.
Secondly under managed care organization there is a consensus to strive towards reducing the cost by beneficiaries again this is true of accountable care organizations.
Third the managed care organisations activities and resolutions made on behalf of the patient are binding to the beneficiary whereas in the case of accountable care organisations their activities carried out on behalf of the patient are not binding to the beneficiary.
Fourth the accountable care organisations are charged with the responsibility of identifying a primary care provider on behalf of the beneficiary. However, in the case of managed care organisations patients can access medical services they want without the need of a referral.
Fifth under managed care organization there is a person charged with pre-authorization of treatment whereas for the case of accountable care organizations treatments is carried out using the patient’s treatment history as the base.
The other similarities between accountable care organisations and managed care organisation are regarding payment contribution to the healthcare providers. They both do determine what share goes to the providers and the number of providers involved in getting this share. This enables both managed and accountable care organisation to bolster their negotiations with providers regarding their future reimbursement.
For the case of managed care organisations, the program mandates a certain minimum number of beneficiaries to 5000 while in accountable care organisations the minimum number of beneficiaries is set at 15000.As safe risk buffer analysis, most accountable care organisations that meets the program quality performance standards, they are entitled to receive a share of their saving that they have been able to generate below a certain specific expenditure benchmark. The same rule would imply the risk of accountable care organisation paying up a certain portion of the losses in expenditure arising above its benchmarked expenditure level.