What is an ACO plan?
Asked by: Cordell Jenkins PhD | Last update: January 24, 2024Score: 4.6/5 (22 votes)
An ACO is a group of health care providers who take responsibility for the total cost and quality of care for their patients, and in exchange they can receive a portion of the savings they achieve. An ACO agrees to work together with Medicare to give patients the best possible care.
What is the difference between a PPO and ACO?
There are a number of important similarities and differences between ACOs, HMOs (Health Maintenance Organizations), and PPOs (Preferred Clinician Organizations): An ACO is generally based on a self-defined network of clinicians, whereas in most HMOs and PPOs, the network is defined by a health plan.
What is the difference between ACO healthcare and HMO?
The purpose of an HMO is to fix the price for health care. The purpose of an ACO is to leverage better, more effective health care practices for the benefit of patients in order to cut costs in the long run.
How does an ACO work?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.
What does an ACO mean for patients?
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and/or other health care providers who work together to improve the quality and experience of care you get.
What is an Accountable Care Organization (ACO)?
What are negatives of an ACO?
Cons: No way to opt out unless you change doctors: If your doctor is in an ACO, then so are you. You have no choice in the matter. Or, if your physician isn't in an ACO, but you really want to be, you'll have to switch doctors.
Do patients know they are in an ACO?
Patient Experience with ACOs
Patients generally do not realize that their care is being managed by a Medicare ACO.
Why would a physician join an ACO?
Reduced costs and increased savings
ACOs work to achieve this by incentivizing physicians to keep their patients healthy and out of the hospital through prevention and avoidance of unnecessary hospitalizations, emergency room visits, and tests and procedures, aka coordinated care.
How do patients benefit from ACO?
Patients whose health care provider participates in an ACO may get: extra help managing chronic diseases. coordination between different doctors or members of their care team. more preventive health services to keep them healthy.
What is an example of an ACO in healthcare?
Examples of this type of arrangement include Mayo Clinic and Cleveland Clinic. They usually do not own a health plan but, rather, have contracts with multiple health plans in their areas. Most have a long history of physician leadership and highly developed mechanisms for providing coordinated clinical care.
What percentage of Medicare is ACO?
Today, ACOs care for nearly 20 percent of all Medicare patients and nearly a third of traditional Medicare patients. This document includes highlights of ACO results in 2020. 2020 was the fourth straight year MSSP ACOs delivered net savings to Medicare.
What is the difference between ACO and medical home?
PCMHs: “Medical homes” in service of the patient
Whereas ACOs are sometimes called “medical neighborhoods,” PCMHs are often simply referred to as “medical homes.” Like a medical neighborhood, a medical home is designed to improve the patient experience, boost population health and reduce care costs.
Is ACO a type of payment?
ACOs are paid through two revenue streams. First, ACO providers are reimbursed through fee- for-service payments like most Medicare providers. ACOs are also compensated by sharing in the savings they create by improving care.
Is Johns Hopkins an ACO?
The Johns Hopkins Medicine Alliance for Patients (JMAP) is a Medicare Shared Savings Program Accountable Care Organization (ACO).
Is an ACO an insurance company?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care professionals that work together to give you better care. ACOs are not insurance plans; you cannot join an ACO.
Is ACO a type of managed care?
An ACO isn't an HMO, managed care or insurance company. Unlike HMOs, managed care, or some insurance plans, an ACO can't tell you which health care providers to see and can't change your Medicare benefits.
Are ACOs effective?
ACOs Can Promote Efficiency Without Undercutting Quality
By providing bonuses for lower total cost of care (and sometimes penalties for higher total cost of care), ACOs promote reduction of waste.
What type of payment does an ACO receive?
Understanding How the ACO Financial Model Works
Providers who are members of ACOs receive fee-for-service payments throughout the performance period (volume-based care rather than value-based care). Then, at the end of the performance period, these payments are adjusted based on the ACO's care quality performance.
Do I need ACO?
As a Medicare patient, you have the right to see any doctor or health provider who takes Medicare. That means you can see a doctor in an ACO and doctors who are not in ACOs. You do not have to be part of an ACO. Part of the advantage of an ACO is that your doctors will share information to improve your care.
What questions should I ask before joining the ACO?
What responsibilities will the physicians in the practice need to take on? How much independence will they have? Will the guidelines be flexible enough to take clinical judgment into account? What bonuses are available to physicians, and how will they be delivered?
How long does it take for ACO?
Given the complexity of the transition to managing risk, launching an ACO or a CIN requires an ongoing effort to achieve high-performing operational status. This effort unfolds in five overlapping stages lasting up to eight years.
How do you qualify for ACO participation?
ACOs must have at least 5,000 Medicare fee-for-service (FFS) beneficiaries assigned to their ACO in each benchmark year to be eligible for participation in the Shared Savings Program.
What part of a patient's care is an ACO financially accountable for?
ACOs have agreements with Medicare to be financially accountable for the quality, cost and experience of care that traditional fee-for-service Medicare patients receive. According to ACO program guidance and specifications, participating in an ACO may involve earned shared savings payments or incurred losses.
What is an ACO in simple terms?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
How many ACOs are there in the US?
As of January 2022, there are 483 Medicare ACOs serving over 11 million beneficiaries.