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8 ACO Healthcare Facts: What is an Accountable Care Organization?

Posted by Jason Wilson, RN, MBA

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Jan 4, 2018 9:45:00 AM

What is an Accountable Care Organization and how can ACO healthcare help providers and patients?Improving healthcare quality in this country is on everyone's mind. One of the innovative approaches to healthcare that came out of the Affordable Care Act (ACA) was encouraging the healthcare industry to create and use Accountable Care Organizations (ACOs). But what is an accountable care organization, and how well do you know ACOs?

Here are eight things healthcare providers should know about Accountable Care Organizations.

1. What is an Accountable Care Organization?

So what is an accountable care organization? ACOs are groups or networks of doctors, hospitals, and other healthcare providers that voluntarily work together to provide quality - and coordinated - healthcare to
Medicare beneficiaries.

According to Kaiser Health News, about 6 million Medicare beneficiaries receive care from an ACO and about 744 organizations have become ACOs since 2011. Combined with the private sector, about 23.5 million Americans receive health services from an ACO.

2. What does ACO healthcare do for patients?

How can ACO healthcare providers provide benefit to patients, and what is an accountable care organization?

Going beyond the basic question of what is an accountable organization, it’s important to consider the benefits to patients. An ACO attempts to bring together all the necessary elements of a patient's medical care and makes sure all healthcare providers involved in the patient's care work well together. This includes primary care, specialists, hospitals, rehabilitation, home healthcare, and more.

One of the biggest problems with the U.S. healthcare system today is fragmentation of care - patients getting the various elements of their care separately with no one overseeing all the parts and pieces collectively. One of the ways the ACA tried to fix this patchwork quilt characteristic of today's healthcare is through the use of ACOs.

According to the Centers for Medicare and Medicaid Services (CMS), ACOs are designed to be “patient-centered organizations where the patient and providers are true partners in care decisions. Medicare beneficiaries will have better control over their healthcare, and providers will have better information about their patients’ medical history and better relationships with patients’ other providers.”

3. Why would doctors or other healthcare providers want to join the ACO healthcare model?

ACO healthcare providers in the Medicare program make more money if they keep their patients healthy. They receive financial incentives if they provide healthcare on a more efficient basis. And, according to CMS, “When an ACO succeeds in both delivering high-quality care and spending healthcare dollars more wisely, it will share in the savings it achieves for the Medicare program.”

During 2014, the third year of the ACO healthcare program, 97 ACOs received shared savings payments in total exceeding $422 million.

The primary care physician is the key element of the ACO healthcare structure. Doctors who participate in an ACO must tell their patients about their participation. Patients who see ACO healthcare providers will see no change in their Original Medicare benefits, keep their freedom to see any Medicare provider, and can request that their doctor not share their medical information with the ACO.

Rural doctors can apply for advance dollars to pay for developing the infrastructure they will need to provide coordinated care. This is a huge incentive that allows for some rural physicians to upgrade their electronic health record (EHR) capabilities.

New report on CCM guidelines and care coordination: Read More

4. What is the Medicare Shared Savings Program?

Medicare created this program to help achieve better population and reduce the escalating costs of insuring individuals.

Participating providers in an ACO share the responsibility for the health of their patients. The program gives the ACO healthcare providers financial incentives to provide better service for less cost and to save money by not ordering expensive and unnecessary tests.

The Medicare Shared Savings Program requires participant healthcare providers to share information via a seamless transition, such as through an EHR. Those who save money get to keep part of the savings.

Providers can choose to try to earn a bigger reward, which means they can also lose money if they are unsuccessful, or they can enter the program with no risk at all.

5. What are some of the organizations participating in ACOs?

Some of the largest insurers in the country - Aetna, UnitedHealthcare, and Humana - formed their own ACOs for the private market. Insurers believe they are very important to the success of ACOs since they have the tracking systems to collect the data on patients and have the internal systems that can evaluate patient outcomes.

In some geographic areas in the U.S., hospitals are forming ACOs by buying up local physician practices so that they will employ most of the providers in the ACO. Hospitals have better access than individual doctors to the large pools of money that ACOs need to create the modern electronic records systems necessary to track patient care.

Considering the question what is an accountable care organization can allow providers to find new ways to provide ACO healthcare benefits to patients.

6. What is a Next Generation ACO Healthcare Model?

According to CMS, “the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.” At the time of this writing, there were 44 ACOs participating in this model.

The Next Generation ACO Model is designed for ACOs that are experienced in coordinating care for populations of patients. The model allows provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer ACO Model and Shared Savings Program. As CMS has stated, “the goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.”

The Next Generation ACO Model includes strong patient protections to ensure high-quality care and, like other ACOs, will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures.

7. How can CareSync support ACO healthcare?

CareSync provides care coordination services, like those associated with Medicare's Chronic Care Management (CCM) program, for patients who receive care from ACOs. ACOs can partner with CareSync to provide between-visit care to patients on their behalf, demonstrate provision of non-face-to-face care coordination as well as the sharing of important patient medical data, and help improve health outcomes.

8. Does CCM have any benefits such as helping to assign or attribute a patient to an ACO?

Chronic Care Management does help assign a patient to an ACO and the practices associated with it just like the Transitional Care Management codes, Welcome to Medicare Visit, and Annual Wellness Visit.

If you are an ACO healthcare provider or just have questions about how CCM can be used to leverage better patient outcomes, increase attribution, and help you achieve your quality and patient satisfaction goals, contact CareSync at 800-501-2984 or email sales@caresync.com

Download a free healthcare white paper about Comprehensive Primary Care Plus (CPC+). Click here. Want answers to frequently asked questions about Medicare's Chronic Care Management (CCM)? Click here for a complete resource for Chronic Care Management answers.  Get a full collection of MACRA resources for healthcare providers. Click here.

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