United by a common desire to provide comprehensive care, share savings, minimize risk and bundle payments for clinical services, healthcare providers have joined together to form accountable care organizations (ACOs). To realize ACO goals, providers require comprehensive yet easy-to-use documentation and communication tools that facilitate care coordination without taking time away from treating patients.
ACO participation requires providers and staff from various practices, clinics and locations to work together more closely than ever before — a unique challenge when each provider has his or her own method of treating, documenting and communicating with patients and peers. Integrated technologies such as Greenway Health’s electronic health record (EHR), practice management, interoperability and analytic solutions bring practices within an ACO together to improve visibility into patient care plans, streamline care coordination and simplify ACO participation and reporting.
An accountable care organization (ACO) is a network of healthcare providers who deliver coordinated care and share financial and medical responsibility. ACOs aim to create an environment that provides high quality care to the patients they serve (specifically those who are chronically ill), with the goal of avoiding unnecessary services and preventing medical errors.
Primary care physicians, community clinics, regional health-delivery systems, hospitals, specialists, post-acute providers and private companies can join ACOs.
Providers who are members of an ACO are required to notify their patients. Doctors and hospitals will likely refer patients to specialists within the ACO network; however, patients maintain their right to choose any care provider at no additional cost. Patients can decline to have their data shared within the ACO.
Medicare, Medicaid and private ACOs are forming throughout the country. The Centers for Medicare & Medicaid Services (CMS) offer several Medicare ACO programs, including Medicare Shared Savings Program, ACO Investment Model, Advance Payment ACO Model, Comprehensive ESRD Care Initiative, Next Generation ACO Model and Pioneer ACO Model.
Currently, Medicare ACOs account for the majority of ACO networks; however, Medicaid ACOs are becoming increasingly prevalent in state Medicaid delivery systems following a Shared Savings Arrangement or Global Budget Model.
Similar to Medicare and Medicaid ACOs, private payers such as Cigna, Anthem, Blue Cross and Aetna are participating in ACO models, aligning incentives with provider groups and health systems to improve care delivery.
Provider members in an ACO work together to develop care delivery programs that incorporate care coordination and focus on health outcomes. HMO member providers are not held directly responsible for the health of their patients and are not evaluated on their overall effectiveness.
Under an ACO model, the patient is not required to participate in the ACO. HMOs compete with insurance companies for patients and pay providers based on their volume of services. Unlike HMOs, ACOs set accountability at the provider level, enabling the provider to target areas for decreasing cost while demonstrating a corresponding improvement in patient outcomes.
Doctors and hospitals are rewarded with bonuses if they meet specific benchmarks that focus on prevention, managing chronic care and keeping costs down. ACOs pay providers for keeping their patients healthy and out of the hospital. Rural or physician-sponsored ACOs can apply to receive payments in advance to help build the infrastructure necessary to maintain operations.
Contact your regional CMS office or national professional association to find ACOs forming in your state or region.