What is the Affordable Care Act and ACO?
Asked by: Estella Beatty | Last update: March 6, 2025Score: 5/5 (21 votes)
How does the Affordable Care Act affect ACO regulations?
The ACA establishes certain duties for participating providers: an ACO has to (1) be willing to become accountable for the quality, cost, and overall care of a defined population of Medicare fee-for-service beneficiaries; (2) agree to participate in the program for at least three years; (3) have a formal legal ...
What is the Affordable Care Act briefly explain?
The Affordable Care Act (ACA) is a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reforms to the health insurance market.
What does ACO mean in healthcare?
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and other health care providers who accept Original Medicare and work together to coordinate your health care.
What is the downside of ACO?
In conclusion, Accountable Care Organizations (ACOs) offer several advantages in healthcare, including improved care coordination, preventive care, and cost savings. However, they also face challenges such as complexity of implementation and potential misaligned incentives among providers.
How Does The Affordable Care Act Work?
Why would a physician join an ACO?
The goal of an ACO is to ensure patients, especially those with chronic conditions, receive the right care, at the right time, at the right place – and they financially reward and incentivize providers to reduce hospitalizations, medical errors, and the duplication of tests and services.
How does an ACO make money?
ACOs are rewarded when they lower growth in Medicare Parts A and B expenditures (relative to their benchmark) while meeting quality performance standards. During the time frame of the shared-risk arrangement of the program,ACOs must repay CMS for shared losses, if they are incurred.
Who benefits from ACO?
Medicare Beneficiaries Served Through ACOs
These models serve Original Medicare beneficiaries, including individuals that are dually eligible for both Medicare and Medicaid. As of 2020, nationally there were more than 10.3 million individuals served by Medicare ACOs, representing 16 percent of the Medicare population.
Do patients know they are in an ACO?
If your doctor chooses to participate in an ACO, you will be notified, either in person or by letter. An ACO isn't the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You're still in Original Medicare and your Medicare benefits, services, rights and protections won't change.
Is ACO better than HMO?
Unlike an HMO, an ACO doesn't make arbitrary cuts or reject services out of hand. It is designed to work with providers to reduce overhead, increase options, and provide better tracking. The hope is that clinics will use resources to track appointments and medication compliance to ensure better outcomes.
Who pays for the Affordable Care Act?
The federal government covers 90% of the cost of Medicaid expansion. Individual Mandate: The ACA also originally included an “individual mandate” or requirement for most people to maintain health insurance.
What is the Affordable Care Act in simple terms?
About the Affordable Care Act
The law has 3 primary goals: Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
How does ACO reach work?
What is ACO REACH? ACO REACH stands for Accountable Care Organization Realizing Equity, Access and Community Health. ACO REACH is designed by Medicare to improve patient care at no cost to you while potentially offering you added benefits you wouldn't otherwise get in traditional Medicare.
Who must comply with the Affordable Care Act?
Who must comply with the ACA? The ACA applies to applicable large employers (ALEs), which are businesses that had 50 or more full-time and full-time equivalent (FTE) employees on average during the previous year.
Is ACO only Medicare?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give you coordinated, high-quality care. An ACO is part of Original Medicare, not a separate plan.
What are the requirements for ACO?
Have a minimum three-year contract; Have sufficient primary care physicians and providers to have at least 5,000 patients (Medicare fee-for-service beneficiaries) assigned; Have processes to promote evidence-based medicine, patient engagement, and coordination of care; and.
How are providers paid in an ACO?
Providers who are members of ACOs receive fee-for-service payments throughout the performance period (volume-based care rather than value-based care).
Is ACO a Medicaid?
A social ACO is funded by a value-based arrangement with a Medicaid health plan and works with existing Medicaid providers to facilitate access to care.
Is ACO the same as PPO?
With a PPO, patients see high premiums but can see specialists and out-of-network doctors without referrals. However, both systems create their networks of doctors and hospitals. “An ACO plan puts greater emphasis on quality care and long-term savings, making care more affordable for patients.”
What is an example of an ACO in HealthCare?
Prominent examples include Hill Physicians Medical Group, Monarch HealthCare, Brown and Toland Medical Group, Heritage Provider Network, Primecare, Sante Community Physicians, and Sharp Community Medical Group.
Do I qualify for ACO?
Eligibility. You are likely eligible if your household's income is below 200% of the Federal Poverty Line, or if you or someone you live with currently receives a government benefit like SNAP, Medicaid, SSI, WIC, Pell Grant, or Free and Reduced-Price Lunch.
What are the two ways beneficiaries can join ACO?
There are two common approaches that will be used to assign patients to ACOs: Beneficiaries can be automatically assigned to an ACO, or they can actively select an ACO. However, ACOs and insurers can design alternative approaches as well. Under this approach, beneficiaries do not select an ACO.