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Q: What Are Accountable Care Organizations?

Asked by Anonymous on July 11, 2018

Julia Pak July 11, 2018

Accountable Care Organizations, or ACOs, are programs that work to provide higher quality care to Medicare enrollees. They consolidate all of the roles that treat patients – health insurance providers, doctors, and hospitals – to focus on primary care.

There are many benefits for patients who participate in Accountable Care Organizations. Firstly, your Medicare benefits will stay the same. Your payments won’t increase and you’ll receive any and all treatments that you require. You can also choose your preferred physician or hospital that accepts Medicare. ACOs allow you, the patient, to continue making important decisions regarding your health.

As individuals become older, they often require more care due to the increased risk for certain illnesses. By collaboratively keeping an eye on patients, health professionals in ACOs can detect and treat diseases earlier, leading to a healthier population.

ACOs are assigned Medicare enrollees at specific locations throughout the United States. There are a few criteria that patients with Medicare have to meet to participate in an ACO:

  • You must be enrolled in Medicare,
  • You must have a primary care service with a physician at an ACO,
  • You must live in the United States or U.S. territories and possessions.

Once you have received at least one primary care service within the ACO, you will be assigned as a participating beneficiary.

How ACOs Have Improved the Healthcare System

Former Secretary of the Department of Health and Human Services, Kathleen Sebelius, has stated that “Accountable Care Organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs.”  Since 2010, ACOs have continued to seek the best treatments for Medicare enrollees to avoid medical delays.

If people with Medicare routinely visit a primary care physician, they can avoid costly trips to the emergency room – this is the thought behind the implementation of ACOs. ACOs have also saved money for the Medicare program. By preventing accidents and other illnesses, ACOs have changed the delivery of healthcare to individuals with Medicare.

How Do Accountable Care Organizations Save Money?

To operate, ACOs must meet certain requirements. For example, for a minimum of three years, each organization must provide service to at least 5,000 Medicare enrollees.As the number of Accountable Care Organizations increase, more individuals have better access to care. Click To Tweet

ACOs were created as a senior-focused part of the Affordable Care Act, (or “Obamacare”). They work by taking responsibility for Medicare patients’ cost and quality of care experience.

Accountable Care Organizations use a “Shared Saving Program” as their payment model to promote efficiency within the healthcare system. Payments to ACOs are directly related to quality, with the overall goal to reduce costs for the government.

ACOs track their performance through data to measure the providers’ success with patients. By helping Medicare enrollees maintain their health, they can share the savings from Medicare. The bottom line is: the better care ACOs provide for patients, the more money they make.

ACO Locations in the United States

As of January 2018, there are 561 Accountable Care Organizations participating in the Shared Saving Program. This number has continued to increase since the ACO’s beginnings in 2010, integrating in the healthcare system to operate smoothly. There are ACOs in almost every state, including the District of Columbia.

The Future of ACOs

Passed in February 2018, the CHRONIC Care Act will increase government support for ACOs. Programs will now be able to incentivize chronically ill patients to seek primary care by offering up to $20 per visit. This means you’ll be paid to seek care from physicians.

Since 2012, the number of individuals assigned to ACOs has more than tripled. Healthcare professionals and government officials have noted how this improved efficiency in ACOs. ACOs have sustainably helped individuals with disease management and preventive care, while saving costs on long-term medical expenses.

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