WCRI – Accountable Care Organizations (ACO’s) – Live

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Accountable Care Organizations (ACO)

The accountable care organizations (ACO)  are healthcare organizations characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

Picture of Woman Extending Hand for Handshake Accountable Care Organizations (ACO's)
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Presenter Partners Healthcare Network – Dr. Chaqutunu

There are 18.2 million lives that are covered by accountable care organizations (ACO’s) in the US.   Any medical condition that has a mental health component is 42% more costly. 

If medical assistants and physicians work in the same physical general area, there is a much better information flow of medical information.  

ACO’s differ from HMO’s on the gatekeeper concept.  Instead of having a Dr. be the HMO gatekeeper, access to enhanced medical treatment and providers is very important. 

ACO’s also provide referral feedback to the primary care physician from the specialist.  ACO’s also provide access to more acute or emergency care when needed. 

The explanation/assessment of  the risk for a certain procedure is more defined to a patent than just the general risks.  (30 year old vs. 80 year old patient).  Personalized consent forms are crucial in this situation. 

The return on investment (ROI) cannot be measured unless the numbers are studied for a large population.  

Physician incentives are very important with transforming the delivery of treatment to patients.   Fitting ACO’s into the Workers Comp arena will be complicated. 

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James Moore

Raleigh, NC, United States

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James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

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