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:
- ACP Summary and Analysis of June 2015 CMS ACO Final Rule
- Comments to CMS regarding 2015 CMS ACO Proposed Rule
- 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 (April 2014)
- CMS Fact Sheet: Improving Quality of Care for Medicare Patients: Accountable Care Organizations (April 2014)
- 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
- 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
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