Accountable Care Organizations
Understanding and Implementing an ACO
An Accountable Care Organization (ACO) is a formally organized entity, consisting of physicians, hospitals and other relevant health service professionals that have elected to join together and are responsible through contracts with payers for providing a broad set of health care services to their Medicare patients.
This entity is accountable for organizing and aligning health care services to deliver seamless, coordinated care whether the ACO is contained within a single corporate structure or is an organized network of independent but associated health care professionals.
The impetus is to change the way providers are paid. Instead of getting paid for each service ACOs reward providers that are able to manage chronic disease and meet certain quality measures, including reducing hospital admissions and emergency room visits. If the quality of care improves and costs are constrained, the systems can share in the savings.
Understanding Accountable Care Organizations:
- CSS Medicare ACO Attribution Workgroup Webinar (Feb 19, 2013)
- CMS presentation on Medicare Shared Savings Program and Subspecialty participation in ACOs (Nov 27, 2012)
- CMS Fact Sheet: What Providers Need to Know: Accountable Care Organizations (March 31, 2011)
- CMS Fact Sheet: Improving Quality of Care for Medicare Patients: Accountable Care Organizations (March 31, 2011)
- Joint Principles of Accountable Care Organizations - Released in November 2010 by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), ACP, and the American Osteopathic Association (AOA)
- ACP Policy Statement Pertaining to the Development of the Accountable Care Organization Model (April 2010)
Medicare ACO Programs
Medicare offers several ACO programs, including:
- Shared Savings Program
A Shared Savings Program facilitates coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. Learn More - Advanced Payment Model
The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Learn More
CMS will be accepting applications for an additional round of Advance Payment ACOs beginning August 1, 2012 that would begin on January 1, 2013. Get the Application
ACP Comments to the CMS Centers for Medicare and Medicaid Innovation's Advanced Payment Initiative
- Pioneer Model
A more advanced ACO, the Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. Learn More
ACP Summary of New ACO Initiatives through the CMS Innovation Center - Pioneer ACO Model, Advanced Payment Initiative, and the Accelerated Development Learning Sessions (announced May 2011)
Accelerated Development Learning Sessions
These sessions are intended to provide the executive leadership teams from existing or emerging ACO entities the opportunity to learn about essential ACO functions and ways to build capacity needed to achieve better care, better health and lower costs through integrated care models. Learn More
Additional Resources
What's New
February 2013
- On Tuesday February 19 at 1:30pm ET the CMS Provider Communications Group will host a National Provider Call on PQRS and eRx Incentive Program
- On Thursday February 14th at 2pm ET CMS is hosting a ACA Implementation Update to review the Physician Sunshine Rule and provide an update on the outreach and enrollment efforts for the new Marketplaces and how health care providers fit into that work.
January 2013
- On Wednesday, January 9, HHS is hosting an Affordable Care Act Implementation Update for Clinicians, Hospitals and other Healthcare Providers. Gary Cohen, Director of the Center for Consumer Information and Insurance Oversight, will provide an overview of the recent Insurance Exchange regulations and guidance and discuss how it impacts clinicians and hospitals.
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