The concept of Accountable Care Organizations (ACOs) may not be new, but it is evolving and gaining traction. The Centers for Medicare & Medicaid Services (CMS) has made its strategic direction clear: It’s committed to growing ACO models to achieve its vision of “a health system that achieves equitable outcomes through high-quality, affordable, person-centered care.”
For example, with its ACO Primary Care Flex Model, CMS is offering a more flexible payment design to encourage primary care physicians to participate in the Medicare Shared Savings Program (SSP).
Physician practices—especially independent practices—often question the viability of joining an ACO. But even if aligning with an ACO hasn’t seemed practical in the past, you may want to reconsider your options. Whether you’re new to the ACO conversation or just need a refresher, here is a quick look at the ACO landscape.
What is an ACO?
ACOs are groups of physicians, hospitals, and other health care providers who share responsibility for coordinating care, ensuring quality care, and reducing the cost of care for a defined patient population. As such, they help physicians move away from more traditional reimbursement models and advance toward value-based care.
At their core, ACOs take a “whole-person” approach to health that emphasizes preventive and proactive care. Many ACO models call upon primary care providers to act as “quarterbacks” who coordinate appropriate services. While ACOs have goals and values similar to business models like Clinically Integrated Networks (CINs), there are important differences. Typically, the term ACO refers to an entity participating in a Medicare ACO program that manages care for original Medicare beneficiaries rather than multiple lines of commercial business.
What are the benefits of an ACO?
Compared to traditional reimbursement models, ACO models are designed to incentivize providers to deliver more preventive and holistic care. As a result, patients may enjoy a more patient-centric experience and better outcomes.
However, ACOs are fairly “invisible” from a patient’s perspective. Patients may receive a letter stating that their primary provider is in an ACO. They may also receive educational information about the benefits of their provider’s participation. Still, they are free to seek care from other providers if they wish. It’s not patients who participate in an ACO, it’s the providers.
From a physician’s perspective, ACOs may provide an opportunity to align financial incentives with the kind of patient-focused care they want to deliver. The emphasis on whole-person care might also make it easier for practices to attract and retain patients.
ACO programs use various financial models, including capitation and shared savings, to incentivize high-quality care. Physicians should join a model earnestly structured to nurture the win-win relationships that are so vital to ACO success.
How does CareAllies support ACOs?
For more than twenty years, CareAllies has helped physicians navigate the continually evolving ACO landscape. Our subject matter experts strive to ensure physicians understand not only CMS requirements but also their CMS data.
Deriving actionable insights from data is crucial to ACO success and improved patient care. That is why we offer the insights and support participants need to improve performance in an ACO. Some may want assistance with quality reporting and patient outreach, for example, while others might need access to value-based care nurses and workflow optimization resources.
So, are you ready to explore your options? CMS is committed to growing participation in ACO models, and CareAllies is committed to helping physicians adapt and thrive in value-based care. See how CareAllies can support your ACO journey.